Wednesday, March 25, 2015

Executive Function

Remember when I told you that after the heart procedure I had some cognitive problems. I couldn't find words and had trouble organizing things. Well, last night I was trying to put my next annual physical checkup in Google Calendar and noticed that I had double-booked a visit to the podiatrist with an appointment to get my hearing aid fixed. Those audiologist appointments are hard to come by, and I had postponed that one several times. I wan't looking forward to calling the nice lady and explaining that I had f--ed up again. As I tried to fall asleep I was going into my quiet space to calm the anxiety and cortisol build-up that I have learned comes with agitation and irritation.

I made it through the night and checked my paper calendar in the morning and realized that I had already rescheduled the audiologist until June. Is this a memory problem or an organizational problem? It's the worry that comes on automatically that is the damaging part.

Podiatrist vs Orthopedist. One of you asked, "Why would you go to a Podiatrist instead of an Orthopaedic Surgeon (MD) ?" 

Tell you the truth, I was never sure of the difference between a podiatrist and an orthopedist. It turns out that they both get medical training and what they do overlaps a lot. The podiatrist was in the UVM Healthcare system, so I just took the referral. It is a mixed thing. The general practitioners do not know something like Charcot Foot when they see it (although my cardiac rehab nurse knew), and the podiatrist didn't take care not to put sticky stuff right on bare skin, because the skin tears when the stuff is removed. An orthopedist is supposed to be better at viewing the whole system.

One reason not to go to a orthopedic surgeon is that surgeons want to do surgery. That's what they prepare for and are good at. I hope to avoid surgery, so I will go to someone who is interested in mobility.

Graphic Interlude.

One nice piece of feedback from Pinkwater is his comic, Norb, by Pinkwater and Auth.
I have no idea what the plot line means, but I am proud to have a Pinkwater character named after me. And if Voluble's plot is thwarted, you have my avatar to thank.


I saw Stephen Merena today and found that the wound is not getting any smaller, but it isn't getting worse.  I asked whether we could put the sticky padding with the relief hole right in the boot so it wouldn't be sticking to my skin. OK, let's fashion an insert that has twice the relief as what was in the boot before. Still the best thing is to stay off of it. This fix allows a regular thin bandage and wrap on my foot and the boot does all the relief work.


Becka Roolf suggest that I might rent a handcycle. It turns out that there is a guy right in Burlington, the Northeast Disabled Athletic Association. Patrick Standen and I have a date to try out one of his rental bikes. While looking for handcycles, I got to talk to Joe Connelly at RunVermont. I used to do the Vermont City Marathon timing when we were using the hand-timing system, way before the chips they use now. It was nice to catch up.

Executive Function Update. I think I am being pretty creative

Monday, March 23, 2015

The Walking Boot

To be clear, I am not supposed to put any weight on my left foot. I can't feel anything, so to allow the lesion to heal before it creates the condition called Charcot Foot, I must bandage the foot so that there is relief  where the wound is and keep off it. It is a No-Walking Boot. Or at least a Minimal-Walking Boot.

I figured out how I can row with the boot in the left foot stretcher but with pressure only on the heel. I think this will be OK, but the test will come this Wednesday when I see the podiatrist for follow up.

As you can imagine, it is very frustrating to be getting only about 50 minutes a day of light exercise; but that can be endured.

I finally figured out that crutches would help. I put out a call to the bike list and immediately got several offers of not-being-used crutches to borrow.

The podiatrist may be able to fashion an orthotic device which will allow me to do some biking; but first the wound has to heal. I am repeating that because I am not very good at letting things heal on their own.

On Monday I saw my primary. He encouraged me to continue this blog. Other people read it and realize they are not alone. I am impressed that as part of his preparation, Scott Luria reviewed this blog. So, in keeping with the openness of this dialog, I post Scott Luria's summary (which I got from the MyHealth Online electronic communication platform.):

"David is here for his annual exam. As is well documented in his medical record and his own personal blog, this has been a very eventful year, starting with his heart attack and stent placement in December, his post-event episode of delirium which was thought initially to be due to a seizure, but after which he had a negative EEG and was able to taper off of his levotirecetam. More recently, he has been troubled by a neuropathic ulcer in his left foot, that has required the foot to be immobilized. He has had a couple of rounds of antibiotics and the infection is now gone, but he still needs very careful follow-up with his podiatrist, and will be seeing him in 2 days.

This is been an emotional adjustment for him, as outlined in his blogs. He is finding that mindfulness and meditation have been quite helpful. Fitness is very important to him, and this has been challenging with the large boot that he has to wear on his left foot, but he finds he can manage on a rowing machine. He hopes he can have footwear more conducive to exercise arranged soon.

He had questions about the need to maintain high dose atorvastatin and his beta blocker metoprolol. I feel he should maintain both for at least a year since the stent, but he will be in touch with his cardiologist. He will be able to stop the Plavix at the one-year point."

A really great thing about social media is the increase in communication for medical and psychological connection  -- a nice challange to use the blog creatively. And I am glad to see the medical community using the medium so freely.

Then I picked up the loaner crutches. I am looking forward to taking a jaunt around the block.

On Wednesday I see the podiatrist..... [to be continued]

Saturday, March 7, 2015

Foot Problems and Stress Management

The most effective way I have found to manage stress, anxiety and depression is to get a lot of exercise. That's completely in line with what the cardiac rehab folks want you to do to get back you heart function, get rid of plaque buildup, tone the muscles and reduce your chances of a recurrence.

So a couple of weeks ago I was chugging along on the treadmill at cardiac rehab and it felt so good that I decided to try jogging a bit. Being able to hold myself up with my arms would make the impact more gentle on my feet. I did a couple of intervals of 1 minute on 1 minute off jogging. This evidently was the very repetitive minor trauma that can lead to Charcot Foot, "...most commonly due to diabetic neuropathy." Well, I have the neuropathy but not the diabetes. (Serum glucose 79). Although a lot of my symptoms present as diabetes, and each doc I see asks if I have ever been diagnosed with diabetes, I do not have diabetes.

When the podiatrist explained that not treating this could lead to amputation, I got to practice my "learned optimism," that we were going over in Stress Management. "I'm so glad you caught this early," I found myself saying. The X-rays did not show any evidence of neuropathic arthropathy.

The repetitive trauma opened up a lesion on my left sole where a callus had built up, and then the wound got infected. I went through a couple of courses of antibiotics, which cleared up the infection, but the wound did not heal. The podiatrist took a look, shaved off some excess callus, and put me in a boot.
It's a cumbersome thing with an air bag that you inflate to immobilize the foot but still allow some walking about. I thought I could row with it, but that was awkward. So I took an old Teva and hollowed out a relief so the wound would not be pressured.

Well, no. That's not a good idea. The podiatrist wants me in the boot exclusively. Only out to sleep and to shower. The doc fashioned a cushion with a cutout where the lesion would not press on the innersole of the boot, and some of the sole itself was removed to leave a pocket. The cushion has one sticky side, which he attached to my foot to prevent sliding. The doc gave me extra cushion material, so I assumed that I should change the cushion each time I showered and changed the bandage. The first time, however, some skin came off with the cushion and left a bloody cut. Linda is getting good at bandaging.

I'm trying to be positive about this, but 6-9 months in the boot is not pleasant to anticipate. Better than amputation, though. How to manage the stress of a long-term disability? That's what the stress management class is working on.

Here is a good summary of Martin Seligman's Learned Optimism

Each time a worrisome thought comes along, I think of something else and relax my shoulders. We are going to work on other stress reduction techniques next week.

It will be a challenge to find an exercise l can do with this boot.