The Other Side of Medicine

It should be noted that I provide only information and do not endorse any recommendations that the I give herein, nor does it recommend any particular treatment. The treatment used should always be selected by the patient and his/her doctor.

Purpose

Sooner or later, everyone interacts with the health care system.  I propose to tell it like is has happened to me.  This idea came to me while I was in the hospital recovering from a radical prostatectomy.  It is intended for a wide audience, but especially for physicians.

Perspective

I have been involved in the health care field as a physician providing direct care to patients (31 years as an ENT, 2 years as a general medical officer (prior to my specialty training) in the U.S. Air Force, 5 years as a physician in training), a physician working as a Medical Director for a managed care company (9 years working for Prudential HealthCare, MetLife Healthcare and Aetna Healthcare), and the last 5 years working for the Veterans Administration.  I am now a patient in the system, having retired from the VA.  I returned to the V.A. on a part time basis 18 months after my retirement.  This gave me a total of 53 years working in some part of the health care delivery system.  I am a direct person, and will have little left unwritten.  My intention is to inform, not make any disparaging remarks or unkind statements.  I am a third generation Texas physician, fourth if you take into consideration my mother's side of the family too.  I greatly respect the role of the physician in the delivery system, and admit my bias.  I think my personal experiences have made me much more compassionate with my patients.  I also better understand things that are wrong with the delivery system from a patient's point of view.

Experiences of surgery and other health issues

Tonsillectomy - June 6, 1944

Memories from my childhood do not last well, especially those that are somewhat unpleasant.  I remember we listened to the radio in the car on the way to the clinic where I was to have my surgery.  It was D-day 1946.  Young people will need to know that at that time, kids died from the results of tonsillitis as this was before antibiotics.  Penicillin was available in small amounts for use in the armed forces.  Sulfadiazine was available, but not widely used.

My dad had a satellite office in a small medical building where there were several physicians.  The doctor who owned and operated the building was an EENT.  He did minor surgery in his office, the common practice of the time.  We are returning to this method slowly, mostly because the insurance companies are reluctant to pay for surgery done in a doctor's office/clinic at the same rate as they do for a hospital.  Billions of dollars are wasted because of their short sightedness.

I don't remember my T&A as a big deal.  I remember breathing funny smelling stuff (ether) and then remember having a sore throat for a few days, but not worse than those experienced with infections.

Right ankle - 1968

I began having pain in my right ankle when I was in college.  One of my friends ran track, and he invited me to run with him.  After trying to run around the track once, my ankle killed me the next day.  In my last year at Baylor, my mother was diagnosed and treated for adenocarcinoma of the stomach.  She had surgery at the Mayo Clinic.  My dad asked me to come to Rochester to stay with mom so he could get back to work.  I left college about a month early (April 1957) and went to Mayo's.  Mother recovered from her surgery without much problem.  While I was there, my dad asked me to see someone about my bad ankle.  A diagnosis was made of a rigid flat foot.  I had been turned down by the Navy for a flat foot.

As I got older, my ankle became more and more painful.  When I was a general surgery resident, if I had to stand several hours during surgery, I needed help from a cane to be able to walk the next day.  This is one of the reasons I chose to be an ENT doctor, as most of the work could be done sitting down.  During my last year of residency I had surgery on my ankle, performed by the chief of orthopedics at the medical school.  It was quite an experience.  I started my medical practice in July 1968 in a cast.

One of my favorite "medical" stories is about my experience the night after surgery at the local county hospital.  Some time during the night, my foot fell off the pillow that was keeping it elevated.  I had so much pain from the bone graft taken from my right pelvis that I could not lift my foot.  I called for the nurse and asked her to help me get my foot back up on the pillow.  Unfortunately, she spoke no English.  This was time of nurse shortages, and nurses were recruited from around the world.  This nurse was from the middle east.  After a short while, she came back and gave me a pain shot.  I went to sleep, only to wake up again after a few hours with my foot still off the pillow.  I called the nurse again, and the same thing happened, another pain shot but no help with getting my foot back on the pillow.  When my room mate's girlfriend came in the next morning, she put my foot back up on the pillow.  It was an interesting arrangement for my room mate.  His girl friend came each morning, helped him shave and clean up.  His wife visited him each evening.

I continued to have a lot of pain after surgery.  The orthopedic doctor offered me more surgery.  I chose to see one of my medical school and college classmates who was a rheumatologist in Tyler.  He injected my ankle with steroids and it helped a lot.  He recommended warm paraffin baths and I slowly improved.

As years went by, my ankle became more and more painful.  I remember in 1994 having a lot of pain after playing  rounds of golf.  This was at the time we moved to El Paso, and I quit playing golf.  My ankle continued to cause me trouble to the point that I could not walk two blocks without having pain.  More about this later.

Right knee - 1978

I was working with my bird dog in the driveway at home.  The dog was on a lead and we were working with basic commands: whoa, sit, heel, come.  I turned around on my right foot, felt a snap in my knee followed by pain.  That weekend, we were to go on a field trial, and riding my horse was a problem, as bowing my legs around the horse intensified the pain.  Being optimistic, I waited for things to resolve.  After three months without any significant improvement, I sought medical help.

I chose an orthopedist with an excellent reputation in knee surgery who was also on the leading edge of arthroscopic surgery, which was quite new at the time.  I still remembered how much pain my older brother had after open knee surgery.  The surgery went well and I had considerable rehabilitation to do, as I had a lot of muscle atrophy as the result of living with the injury for several months.  As I look back on this event, delay caused nothing but more problems.

Left knee - 1982

My first (and last) experience with spring skiing resulted in an injury that would plague me for a long time.  I was making a slow turn in wet snow and heard and felt a loud pop in my left knee.  I had torn the hamstring tendon as it inserted into the knee.  I sought care from my orthopod when I returned to Dallas and he suggested a period of watchful waiting.  When I was still having pain after several months, he scoped my knee only to find non-specific joint inflammation.

My left knee still hurts to this day, especially after standing still for a while.  I have pain also when I walk.  It has caused me to abandon golf and walking, my two great loves and principle exercises.

Radical prostatectomy - 2002

I had been dealing with urinary symptoms for a number of years.  I had been taking some kind of alpha blocker with some relief, but not total. I went to a urologist to see if one of the newer office procedures might be of help.  As part of the work up, I had a digital rectal examination (DRE) that was normal, a sonogram that was also normal, and a repeat of my Prostate Specific Antigen (PSA).  I had been having PSA's done annually for about ten years, or soon after the test became available.  My PSA had been elevated from the beginning, but less than 4.  This PSA test came back 6.2, quite a jump from the previous level.  My urologist told me not to worry as my exam was normal.  I got a second opinion.  This led to a needle biopsy and a diagnosis of "early" adenocarcinoma of the prostate.  The needle samples were negative on the right side of the gland.

I did considerable research on the Internet and with the help of my new urologist, who is quite knowledgeable about this disease, I decided on a course of therapy.  My doctor had urged me to consider brachytherapy (seed implants).  I was reluctant, as if you have radiation as your primary treatment, then surgical options for recurrence are limited.  I chose to have a radical prostatectomy to enable us to stage the disease more accurately.

It turned out that this was a good choice, as there was penetration of the capsule of the gland on the right side, where the previous needle biopsies were negative.  It was recommended I have post-operative radiation to kill residual tumor cells.  Pelvic lymph nodes were negative, and my CT scan and bone scan revealed no visible tumor spread.

My radical prostatectomy surgery went well.  The doctor was pleased with the procedure and could find no clinical evidence of disease outside the prostate.  The surgical procedure took about two hours.  I spent a while in the recovery room, but have no memory of anything after receiving Fentanyl in the OR by the anesthesiologist.  I don't remember returning to my room on the floor.  I do remember the pain in my belly when I finally woke up.  After getting an "extra" dosage of morphine, I felt better.  The pain was still there but I didn't care as much.  The first 24 hours after surgery went well, and I had little memory of most of it.  My memories really started the morning after surgery when I was expected to get out of bed and sit in a chair.

The engineer who designed the hospital bed never spent any time in it as a patient with a sore belly.  The mattress was so soft you could not "scoot" around.  There was nothing high enough over your head to grab to help you move.  The bed rails were split, but not in the middle of the bed where humans usually enter and leave.  You had to scoot down toward the foot of the bed to be able to get out around the upper rail.

I felt pretty good on the second day.  I was able to enjoy visits from several people and talked on the phone to others.  I was not taking anything by mouth (NPO) other than ice chips.  I was getting plenty of fluids by the IV route.  I gave myself a dosages of morphine with the PCA (patient controlled administration) button when I felt I needed it.

I began to have discomfort in my right thigh.  The doctor had put wide bands of adhesive tape over the catheter that was in my bladder on the right thigh and had written on the tape "Remove under penalty of death signed Obama Ben Laden"  He had warned that if the catheter came out prematurely, it would not be an easy task to reinsert it.  There was redness adjacent to the tape.  After complaining to the doctor, he had the nurse remove the tape and the skin under the tape was blistered like a second degree burn.  It covered an area of about 4X6 inches.  It took several weeks for this area to heal completely.  I had never been "allergic" to tape before.  I have subsequently found that some Band-Aids do the same thing.  I seem to be able to tolerate paper tape OK.  

The third day I got up out of bed and took a walk in the hall with the assistance of a nurse.  I did better than I expected.  In the afternoon, the fun began.  I started having intense back pain and muscle spasm.  This was my old friend that started when I was a child and had intermittently hit me since.  I have never been able to stay in bed longer than 7 hours without having back pain.  I typically get low back pain in the evening that is relieved by lying down.  This pain was not low back, but had a trigger point that felt like it was under my left shoulder blade.  The pain was triggered by moving any part of my body.  It felt like I was being hit with a cattle prod.  The morphine did not seem to give any relief.  My doctor does not typically make rounds in the evening, so I was unable to communicate with anyone other than the nurse.  About 10:30 PM the pain was so severe, the nurse called the doctor on call who prescribed one muscle relaxant pill.  About midnight, I thought of calling my wife as I though I might not live until morning.  I was unable to take a deep breath without triggering the pain.   The back pain completely overpowered any belly pain I had.  I finally got a little sleep from 2 to 4 AM.

This is the "quiet time" in a hospital.  Other than these hours, there was someone in my room almost every hour.  The hospital uses the "team" approach.  One person cleans the room, another person takes vital signs, another person changes the IV's, another person gets you out of bed, changes the bedding and offers to assist you with a sponge bath.  A variety of people empty the catheter bag.  I reminded them frequently with the IV was out or the bag was full.  I hope they enjoyed my reminders.  The nurses were good and I had good care.

When my doctor showed up the third morning after surgery, I told him I was dying.  He immediately was concerned that I may have had a pulmonary embolism (PE).  He also mentioned I could be having kidney pain from a blocked ureter.  I was convinced it was nothing other than my chronically recurring back pain.  He got an internist involved who ordered some tests and recommended an ice pack to the trigger point.  I have always used heat, and had been using a heating pad for the last twenty four hours without relief.  The ice was miraculous....within 20 minutes the pain resolved and I could move a little without setting it off.  By this time, I was sitting up in the chair, as I could not stand to be in the bed.

To satisfy everyone that I had no PE or blocked ureter, I was carted to X-ray in a wheel chair and had a chest x-ray and a kidney sonogram.  A technician did a Doppler leg vein study in my room.  All of the tests were OK.  The bad back was the culprit.  I also was having fluctuating temps because I was unable to breathe properly.  I was started on antibiotics.  I was offered Keflex, which I refused due to my penicillin allergy.  They started me on Levaquin.

I asked the nurse to find me a recliner to use, rather than get back into the bed.  They were unable to find one (hard to believe that there is not a recliner in a 600 bed hospital somewhere), and my wife with the help of my best friend brought my trusty recliner from home.  The recliner and the ice pack saved my life.  I used the ice about every two hours for the rest of my hospital stay.

About this time, I started passing gas.  The doctor recommended a Dulcolax suppository to get things moving.  It worked, but I was unable to get someone to respond to my call button to assist me in getting to the bathroom.  I lost part of the paltry contents of my rectum in the floor on the way to the bathroom.  I had nothing to eat by mouth since Sunday, and after drinking a gallon of Go Lightly, there was nothing left in my bowel.  I did pass considerable gas.  I was still NPO and using the morphine.  On the fourth day, nothing much happened.  I continued to get up and walk, the back pain was better, and my bowels continued to growl and I passed a little gas.  My doctor did not show up at all that day.  He did call me from his car about 6:30 PM.  I suggested we try some food and different pain medication.  The morning of the fifth day, the nurse removed my IV (with considerable encouragement from me after she was unable to move it to a different location), started my on oral pain medication and clear liquid diet.  The doctor suggested another Dulcolax suppository, which I gently refused telling the nurse the story of the previous one.

The morning of the sixth day I had real food....bacon, eggs, biscuit, juice, coffee, milk and all tasted very good.  The doctor on call for the weekend came by, and I asked him to look at my drain, as the site around the drain was very red and inflamed.  There had been little drainage for several days.  He removed the drain and gave me discharge orders to go home.  My wife transported my trusty recliner home with the help of our son, and I was free....except for the catheter.

Getting home felt good.  I continued with the ice treatment and stayed in the recliner for the first night home.  My back was better enough by the second night to get in my own bed.  We have a wonderful bed at home.  It adjusts like a hospital bed and has a mattress that is semi-firm and conforms to your body.

The next two weeks had my mind focused on a very localized area....my urethra.  The catheter has a way of exposing the urethra and it rubs against the absorbent pad every time you move.  As a result, I chose to move as little as possible.  I did some walking, but discovered if I held the catheter as still as possible, the pain was reduced.  I continued to improve slowly, have less belly pain and became more mobile.  The majority of the pain by this time was associated with bladder spasm.  This was intensified with each bowel movement.  I continued to take Metamucil to keep my stool soft to avoid straining, which was painful.  I was waiting for the day when the catheter would be removed.

My doctor had cautioned me when I was in the hospital that if the catheter comes out during the first week, it requires a surgical approach to replace it.  When I went for a visit to his office during the second week, he offered to remove the catheter, but warned it might have to be replaced.  I decided to hold out for his traditional three week period and left the catheter alone.

Leg catheter drainage bags are poorly engineered, at least the one was they fitted me with when I left the hospital.  The bed bag has a vent in the tubing that allows better flow into the bag.  The leg bag has no vent, but has a one way valve in the inlet.  It just doesn't work as well, and during the times I wore the leg bag, I seemed to leak more urine beside the catheter than went into the bag.  As a result, I wore the leg bag only when I had to.  I felt OK and could have been more mobile and left the house more often if the leg bag functioned better.  I could not imagine trying to get back to work wearing a leg bag.

My first venture outside my house was to walk a block to a neighbor's house to help her with her computer.  It went OK.

My small group (The Gray Panthers) was great to me.  This group meets weekly for dinner, fellowship and Bible study.  I helped organize the group about 1985.  The Panther's came to my house the first Thursday night and the meeting went great.  We had the usual popcorn, cold drinks and as an added treat, Jane put out Hershey bars that were a hit.  We continued our study of the second chapter of Hebrews.  The next week was my first social venture outside the house and one of the guys picked me up and we went to our usual meeting place, The String Bean restaurant on Coit road.  We had a good time, and I handled the travel fairly well.  We worked on the third chapter of Hebrews.

The day came for my three week visit to the doctor and the proposed removal of the catheter.  I had a voiding cysto-urethrogram to assist the doctor in seeing how I was healing and if there was any extravasation (leakage) outside the bladder.  There being none, the catheter was removed.  The doctor said it would take a few weeks to regain control over my newly recreated sphincter and bladder neck.  He liked what the X-rays told him.

The first week without the catheter was a totally new experience.  My bladder was still very reactive and did not hold much until I felt the urge to urinate.  I usually did not make it to the bathroom and went through a number of "Depends" for men.  I did better at night.  I seemed to be OK when lying down or sitting perfectly still.  Movement resulted in a need to urinate associated with urgency.  I told myself that there must be considerable raw area in my bladder neck and urethra that needed time for healing.  I was also on an antibiotic for the first five days after removal of the catheter.  I progressed slowly and became frustrated.  At least I was not dealing with the pain as when the catheter was in place.  I slept poorly, waking up about every two hours with the need to urinate.  I am a terrible sleeper anyway, and most nights would be wide awake about the third time I had to get up.  I tried to make up for my lack of sleep by taking a nap after lunch.  Each night seemed to be better then the previous one.  Last night was the 6th night after the catheter came out, and I was able to get back to sleep and did not get up until 6:30 AM.

 Left knee - 2005

When we were living in El Paso (1994-97) I began having pain in my left knee.  For some reason, I did not seek medical care.  I figured it was just more wear and tear.  The knee became more and more painful and about 2004 I began searching for an answer.  I thought I was a candidate for a total knee replacement.

I went to see a very experienced orthopedic surgeon whom I had known during my time in practice at Medical City.  I was having chronic problems with both my back and knee.  He did not do knee work, and recommended a doctor who did Synvisc injections, as he thought this might be of help to me.  I had a visit with this doctor, my first and last.  I had made an appointment well in advance and showed up early only to wait two hours before seeing the doctor.  I learned that he had not communicated with his office of another commitment.  My gripe was that no one in his office came out to the waiting room to let everyone know why the doctor was running late.

About a year later, I went to see another doctor about my knee.  He did not think my symptoms were compatible with his physical and the CT x-ray findings.  He said he was reluctant to offer me surgical treatment, as he did not think it would help.  I sought another opinion.  This doctor ordered a MRI and told me I had a torn cartilage.  I had surgery and immediate improvement in pain.  My knee continued to feel weak compared with my right.  I had trouble with steps, both up and down.  The MRI said I also had a torn ACL that explained my loose joint issues.  I was too old for an ACL surgical repair.  The fix was a total knee.  He did offer me a trial of Synvisc and I had an injection.  A few days after the injection my knee became very painful and in the middle of one night, I was unable to get out of bed by myself.  My arms were so weak I could not lift them to get a coffee cup out of the kitchen cabinet.  I could not get up off the commode without great difficulty.  We had previously installed a higher than normal toilet and grab bars which helped a lot.

Polymyalgia rheumatica (PMR) - 2005

 I called my internist with the new symptoms, and over the phone, he diagnosed me with polymyalgia rheumatica (PMR) and started me on a steroid dose pac.  Within 24 hours of starting the steroids, I had a miraculous recovery of my muscle weakness and pain.  My father used to tell a story about the first patient he had treated for pneumonia with penicillin in 1944 and her dramatic recovery from near death.  My recovery from PMR was the most dramatic thing I had seen in my medical life.

I went for a follow up visit with the orthopedic surgeon.  He said he had never seen this kind of reaction to Synvisc.  I elected to not have the second injection!

 My internist recommended I see a rheumatologist.  I started making calls.  The doctor he recommended did not take patients with insurance.  It was cash on the barrel head!  I called a doctor at the medical school recommended by my wife's pulmonary specialist who could not see me for three months.  The administrative assistant I worked with at the Bonham VA clinic recommended a doctor who had seen her son.  I called his office and he was not accepting new patients.  The assistant got on the phone and got me an appointment.  This doctor saw me and helped me a lot.  I am now more than four years beyond this illness and hope I never see it again.  I was on systemic steroids for a year and non-steroidal medicine for a year.

Right ankle - again in 2008

During a visit to California to visit friends in January of 2008 I was unable to walk around and enjoy the weather.  I made a decision that I did not want to spend the rest of my life not being able to walk.  I was having almost constant pain in the ankle, even if I did not walk.  I previously sought consultation from my wife's foot doctor in 2006 who offered me a steroid injection.  I elected to continue with the pain rather than temporary relief from steroids.    As part of my knee work up a the doctor's PA recommended I see their foot and ankle doctor, which I did.  He put me in orthotics.  It immediately helped my right knee and hip pain.  I used the orthotics for the next two years, but they were not the answer for my ankle pain.

I did get temporary relief of pain from a steroid injection in the fall of 2007.  We took a trip that involved considerable walking and it helped a lot.

After my California experience, I returned to see the foot and ankle doctor and asked what more could be done.  He recommended revision surgery of my ankle.  He said the problem with my first surgery 40 years ago was they only gave me a 30 year warranty.  I asked him what kind of warranty he would give me, and he said 30 years.  I think this would outlast me!  I elected to have surgery.  Time had partially erased the misery I experienced from the original surgery.  The surgical experience was good.  I had a local nerve block that kept me mostly pain free.  The problem has been the recovery.  I spent two months in a cast and the last month in a walking boot.  When the cast was removed, we found a had a significant wound dehiscence.  The incision was in the old scar and it did not heal.  We began daily dressing changes with little improvement.  It seems the more active I am, the more it drains and fails to heal.  I saw a surgical friend who looked at the wound and found exposed bone and tendon.  He recommended I see a plastic surgeon for a skin graft procedure.  Needless to say, my wife and I were discouraged and disappointed.

A couple of days later, I saw my orthopedic surgeon who immediately said I needed to have the wound surgically treated, which he did later that day.  He removed dead tissue and a tendon that was running across the lower margin of the wound.  It was to provide lateral motion to my foot, and as my foot was fused I no longer needed it anyway.  He agreed about the need to see a plastic surgeon and he arranged for me to see a wound care expert. 

I went to the wound clinic the next day, to find I was to see a friend with whom I had attended medical school starting 51 years ago.  He wanted me to use a wound VAC system.  My orthopedist had recommended this previously.  I spoke with the device representative.  I have a terrible allergic reaction to some kinds of adhesive tape.  The VAC representative thought this might be a contraindication to use the device.  At the wound clinic, at my suggestion, they put a test patch of the adhesive material on my forearm for a test.   They also said I would need to see a plastic surgeon.

My quest for a plastic surgeon was frustrating.  The doctor recommended by the wound care clinic does not accept new patients with Medicare insurance.  Through my anesthesiologist friend, I found an experienced plastic surgeon who would accept me as a patient.  His visit me feel better and said there was a change the wound VAC would obviate the need for him.  Time will tell.  I had the wound VAC system applied this morning. (6/10/2008)

The wound VAC performed miracles and within about two weeks, it was better enough to allow the plastic surgeon to surgically close the wound.  The sutures were left in for three weeks and I continued in a non-weight bearing situation for about 6 weeks.  As I began to bear weight, the wound stayed closed, but I had much pain in the foot.  The bottom of my foot was very tender.  If felt like I was walking on the outside edge of my foot.  The orthopod prescribed a wedge for my shoe that helped some.  He advised me to have a permanent insert for my shoe, but I was unable to tolerate the hard plastic of the insert.

Jane and I sought different shoes.  I bought a pair of Dr. Scholl's sneakers that I was able to tolerate.  We also bought Dr. Scholl's house shoes and some inserts for my regular shoes.  I began to try to walk more on my foot, but not without severe pain.  Over the next four months, I had more pain in my foot than at any time since my surgery.  I went on my much anticipated Colorado fishing trip in August and was not well enough to wade or walk very much.  I tried to play golf, and was able to get through 15 holes until my foot became so painful I could not stand it any more.  I learned a new fishing technique, sitting on a folding chair by the stream.  I caught more fish than ever before!

I remembered using the hot paraffin bath with my first surgery.  He dug out the bath we had bought sometime ago and refreshed it with new paraffin.  I began to soak my foot daily, sometime twice a day.  I gradually noticed improvement and less pain.  As I write this (1/27/2009) I am much better, but still unable to walk pain free.  It is particularly painful if I try to walk barefoot.  The only time I can tolerate it at all is the short times I spend in the shower.

The orthopod told me it would take a year for my foot to be well.  He had told me I would be able to do "everything" after six months.  The six months never happened.  I am one month away from being "well."  I think this may turn out to have been a very bad decision on my part to have surgery.  My goal was to be able to walk more than a few blocks without pain.  That hasn't happened yet!

Over the next few months I had much more pain and discomfort than I had just after surgery.  I had intense burning in the sole of my foot, greatly aggravated by standing and walking.  In October of 2008 I felt I was doing better and began singing in our church choir.  Standing during rehearsals and during a performance was torture.  I had pain in my foot with every step, especially under the head of the 5th metatarsal bone.  It was almost impossible to walk barefooted.  Jane took me to a shoe store and we bought new house shoes and a pair of sneakers with the "Doctor Scholl's" brand.  They had very soft insoles.  I was able to walk with less pain using these shoes.  I learned to my great disappointment I can no longer tolerate my old shoes.  I have one pair of boots I can use, only because they have a very wide upper part and the sole if soft.  They are my old motorcycle boots.  I can't get in my standard "cowboy" boots due to the inflexibility of my foot.

My diagnosis was I was having neurologic pain that was likely secondary to the nerve block I had during surgery.  I knew from the experience our son had after a fractured arm that it would take time.  I got some relief by starting the non-steroidal again.  I started using a hot paraffin bath that seemed to give me some temporary pain relief.  The pain gradually improved and I was able to stand and walk better.  The best guideline I had to improvement was when I walked barefoot to get into the shower.  It is now 14 months after surgery as I write this and I am still not able to stand very long or walk very far without having significant pain.  I have started using a foot vibration unit that was given to me by a friend who was going to give it for sale to "Family Place."  It seems to give me immediate pain relief for which I am thankful.

Broken metatarsal - 2010

In April 2010, I bought a membership in a local exercise facility in an effort to do some self rehabilitation.  I worked out two or three days a week.  After about the first month, when I was working on a machine that lifted weights with my leg muscles, I began having more pain in my right foot.  The pain was very intense and aggravated by walking, especially trying to walk fast.  After a few days I called my doctor for an appointment, but had to wait a couple of weeks before he could see me.  An x-ray revealed a broken 5th metatarsal bone.  It is one of the long bones of the foot.  It was broken at the head just under one of the two painful spots on my foot.  As I look back on this, it probably had been broken for quite a while.  The doctor said he thought surgery would be necessary to fix it.  He said it was a "simple" surgery.  It did not seem "simple" to me.  I gave it some thought for a week and decided to go ahead with the surgery.  I had a conversation at work with our podiatrist who said "conservative" treatment was to be in a cast for three months.  There was no assurance it would heal.  I did not want to spend any more time on crutches.

In May I had the surgery that consisted of putting a long screw in the bone.  I now had an even dozen screws in my foot. Casting was not required, only wearing the orthopedic boot I had used before.  In the boot, I was completely free of pain for the first time in more than two years!  I kicked myself for not going to see the doctor earlier.  I wore the boot for six weeks, then got fitted with an orthotic for my shoe.  When I came out of the boot into the orthotic, I had some pain, but not nearly as much as I had been having.  After a few weeks the pain became less and less.  It is now 4 months after the surgery, and when I first get up in the morning and make my way to the kitchen for coffee, it is pretty much pain free.  After I walk all day or have to stand for any length of time, it gets sore, but not to the extent before.  The intense pain under the base of my little toe had resolved!  I could even walk for a few steps on the hard floor of our bathroom without severe pain.

Bladder problems - 2010

About the first of September, I began to have pain with trying to empty my bladder.  I had this before, but it has been some time.  For about the first five years after my radiation therapy, I had this about every six months.  My doctor told me it was a common radiation side effect.  It usually cleared up in a few days.  This time, the pain lasted for a longer period.  I made an appointment with my urologist, again waiting for a couple of weeks before he could see me.  He and I agreed that a look inside my bladder was indicated.  He said it could be one of several things: a bladder stone, a polyp or bladder cancer!  He said because I had been irritated, I was more at risk for bladder cancer, a thing I knew but have carefully forgotten.  He had tried to look in my bladder several months ago in his office, but he could not pass the scope into my bladder past what he described as scar tissue.  This event would require putting me to sleep.  We had more conversation about options to make my incontinence better.  He is still not positive about the various treatments other than inserting an artificial valve.  I reminded him that my golfing friend had a valve placed, that got infected and had to be removed and now he must wear a catheter 24 hours a day.  I was not ready for this!  We scheduled the procedure (cystoscopy) for October 25, 2010.

Fortunately, nothing "bad" was found at the recent procedure.  I have been going through a period of complete and incomplete urinary incontinence since the procedure.  I played golf yesterday with no more incontinence than prior to the procedure.  I continue to have a constant "drip." 

I have signed up for a seminar put on by our local medical school about incontinence in the hope it will provide some additional information about what I should do at this point.  Jane and I attended the seminar in December and made an appointment to see the doctor in January.

I decided to have surgery which was performed in February, 2011.  It was done at the Zale-Lipshy outpatient hospital at the University of Texas Southwestern Medical School.  Dr. Alan Morey was the surgeon.  The surgery and hospital stay went well.  I spent one night after surgery.  I received excellent care.

My recovery was more complicated than I expected.  I had considerable pain and swelling.  Jane said "think eggplant."  I had only cancelled my clinics for a week, so returned to work.  I should have taken off two weeks, as I was really miserable that first week back at work.  I was still wearing a condom catheter, as the sphincter was not to be "activated" until after a six week healing period.  The swelling and discoloration slowly resided.

I went back for follow-up about a week after surgery and then after six weeks to have the sphincter turned on.  It has a switch that turns it off and on.  There is a capsule device that resides in my scrotum that is about an inch long and houses the switch and the bulb to pump to open the sphincter.  It closes by default after about a minute.  I was instructed to pump the bulb twice.  It seemed to work well.  The problem was that I had been totally incontinent for several months and had almost no bladder capacity.  I had urge to urinate very frequently.  If I did not empty my bladder, the spasms would overpower the sphincter and I soaked the pad.

I complained about this to Dr. Morey and he suggested a medication to try to stop the urge incontinence.  I had urgency to urinate all of my life, but it was worse now.  The medication helped, but it had many uncomfortable side effects.  It made me terribly constipated, a problem that I had since my radiation therapy.  It dried out my mucous membranes and made me cough and clear my throat often.  I was unable to sing well.  My nose got stopped up at night.  After taking it for several weeks, I stopped, as the side effects were worse than the urge to urinate.  I continued to try several options, one to limit my intake.  I quit drinking coffee and it helped.  I switched from brewed coffee to instant coffee and on days I was working only drank one cup in the early morning.

Ruptured disc in low back

The day before my birthday (April 17th) in 2013 I suddenly had terrible pain in my left leg.  It started after getting up from a sitting position.  I was able to get an appointment with an orthopedic surgeon who thought it was greater trochanter bursitis and he gave me a steroid shot in the bursa.  The pain persisted unchanged.  I went back and had a MRI that revealed a ruptured lumbar disc, L3-L4.

I elected to see another orthopod who I had seen 20 years ago about my back.  My back has given me trouble all of my life, but this was something new. Jane had made the correct diagnosis from the onset.  She has had two ruptured discs in her back.  I was offered and given an injection into the nerves at the level of the rupture and I got some pain relief, but it lasted only 24 hours.  I had surgery a month later.  After the surgery, the doctor told me that he did not think the surgery would solve my pain problem, as the rupture was anterior and was affecting the sensory never more than the motor nerves.  I was improved some, but far from being pain free.  He referred me to a doctor of physical medicine who started me on Elavil and I got some pain relief.  I had tried other medications that helped, but I did not want to continue to take narcotics as I did not want to become addicted.  I got better slowly, and was able to get back to work in September, 2013.  I had a long period of physical therapy that helped me begin to regain some strength in my leg and back.

I continue to have pain, but it is tolerable and does not last long.  I get relief by rest and Tylenol.  I had another round of physical therapy that helped to further strengthen my left leg and it improved my walking.  It will soon be two years since the onset and I suspect I am as good as I will ever be by this time.

Cataracts

I have had surgery in both eyes to remove cataracts.  These are age related.  I had the right eye in 2009 and the left in 2014.  I chose a surgeon that one of my friends had gone to evaluate and fix a poor result from another surgeon,  Both surgeries were uncomplicated and successful.  I can now see everything without glasses, but still wear them as I don't want to fool with keeping up with reading and computer glasses.  I recently bought a 32 inch monitor and I don't need any glasses to see well with it!

Spinal cord stimulator for chronic pain

I have had back pain all of my life.  When I was a teenager I had radiation treatment for what was called juvenile ephisitis.  I took a board to put between my mattress and springs when I went to college.  I have what I have called a seven hour back.  If I am able to sleep for seven hours pain in my low back wakes me up.  My back pain has gotten worse as I have gotten older.

I had attempts for "conservative" treatment with steroid injections and an attempt at rhizotomy that did not work.  The doctor who performed my disk operation recommended a spinal cord stimulator to help with pain as he did not think the surgery he did would relieve the pain.  I had a trial, and it did nothing to relieve pain in my right foot or low back and I elected to not have the stimulator implanted permanently. 

I read about a new device called a Nevro HF10 stimulator.  I had been used in Australia for several years and had taken 70% of the market there for this kind of device.  It was approved by the FDA a year ago for use here.  It uses a different mechanism than the Boston Scientific device and works in a high frequency (10,000 Hz) and is advertised for back pain relief.  I had a trial and it worked.  I had the permanent device implanted March 8, 2017.  It has made a huge difference for me.  I can now walk without having back pain.  I seem to have more strength in my left leg and no pain, less pain in my foot.  I had not been able to walk barefooted since my foot fusion surgery but now I can!  I can stand in the shower comfortably.  They say the battery lasts for ten years.  As I am 80 years old, I think that will be enough for me.  I have learned it works better if I keep it charged every day.

Over-active bladder

I had problems with my bladder for many years.  I was told it was a side effect of the radiation therapy I had for prostate cancer.  As I had become a patient of the urology department of the UT Southwestern Medical School I asked my doctor for advice.  He referred me to one of the other members of the department of urology who dealt with this problem.  I had done some reading on my own and wondered if some of the treatments might be of help to me.  I learned that this problem is much more common in women.

I had a visit with the new urologist and he recommended three possible treatment choices.  One was to insert yet another electric device, similar to the one I have for my spinal cord.  He also said Botox was one of the treatment, but it would not cure the problem and had to be repeated about every six months.  The third was acupuncture applied to the tibial nerve.  I chose acupuncture as the least invasive.  It involves twelve 30 minute treatment at weekly intervals.  I have my 10th treatment today.  It has helped some.  Time will tell.  I completed the twelve treatments and I am now getting follow up treatment every six weeks.  I think it has helped some, but has not resolved the problem completely.  I will stick with it for a while longer.  My next appointment is next week (December 2017).

June 15, 2018 I decided to proceed with the Botox injection.  It worked wonderfully.  I kick myself that I did not do this years ago.  I now have to remember to empty my bladder!

Knee

October 4, 2017 I had my left knee replaced with a titanium prosthesis.  The doctor told me the operation would take 45 minutes but it would take me six weeks to get over it.  Today is December 22nd and I am still not over it!

I completed nearly four months of physical therapy and am still not free of pain.  I have been able to walk since the day after surgery.  Now when I walk my back hurts and I have a loud "click" in my left knee that I am sure if you were walking beside me you would hear it.  It is call a patella clunk that happens 18% of the time after total knee replacement.  Scar tissue developed on the back side of the patella and every time you extend the leg the patella hits the femoral part of the prosthesis.  It does not hurt but is terribly annoying.  It is related to the length of stride.  The first thing in the morning when I get up I take "baby steps" as I feel more steady.  There is no noise.  I have been told by my physical therapist that it would resolve.  If is doesn't  it can be fixed using arthroscopic surgery.  I hope it fixes itself!  More surgery I don't need!

Today is April 19, 2018 and my knee has not improved much since the last note from December.  I have no pain when standing.  I have pain after doing exercise, particularly quad ones.  The thump is still there.  I notice it more when I try to walk a normal stride and speed.  I have experimented with multiple ways to walk.  I have not yet found a solution that lasts more than a few steps.

Last updated April 26, 2018

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