When I began rehab, my case manager decided to set me a goal of losing 5 pounds. I cut out chocolate and practiced putting down my fork between bites, and soon I had lost a few pounds and then 8.
I set myself the goal of riding my bike to my 4-month follow-up with the cardiologist. I did that yesterday. I was afraid I might run into my case manager, who had been quite adamant about enforcing the podiatrist's order to stay off the left foot. When I saw Joan in the parking lot, she didn't make any fuss at all. Just said 'Hi.'
The cardiologist has nice eyes and a good bedside manner. I had told him ahead of time that I was interested in reducing my meds as much as possible. I argued that my cholesterol and blood pressure had been OK within the guidelines before the event, so there must be something else, such as genetics, that accounts for my heart attack. Well, actually, once you have had a heart attack, you are in a different statistical group, and the odds change. Besides, the medications have specific effects on the stents and on the likelihood of plaque attaching to them or to the vessel walls; so he want me to be on the highest dose I can tolerate, not the lowest.
Sunday, April 26, 2015
Bootless
Today I got the official pronouncement that the wound on my foot had healed. I can walk using a special insert and I can bike cautiously.
Here are my questions.
- Is there a structural anomaly in my foot that could only be fixed by surgery? No.
- Do I need special-made orthotics? Let's try the home-made solution first.
- Can I make my own inserts like the ones the podiatrist made for the boot? Yes.
Check my feet after an hour of biking to be sure the wound has not recurred.
- Should I use a pumice stone to clear away dead skin? Sure. Be careful.
- Do I need the crutches or the boot? No. I returned the crutches to Ann Naumann at Physical Therapy. She had replied to my post on GMBC-L in about 5 minutes with the offer of her crutches.
No barefoot walking.
Modify the Spenco insoles with a relief hole located by inking around the wound and stepping on the insole directly in the proposed shoe so it is properly located. That worked well. But when I hauled out some old New Balance 998s that had been in the closet, the outer sole separated from the body in a way that left granulated foam so that it was impossible to glue the sole back on. I looked on the New Balance site and found a lifetime replacement policy. I emailed this photo. We shall see.
Here are my questions.
- Is there a structural anomaly in my foot that could only be fixed by surgery? No.
- Do I need special-made orthotics? Let's try the home-made solution first.
- Can I make my own inserts like the ones the podiatrist made for the boot? Yes.
Check my feet after an hour of biking to be sure the wound has not recurred.
- Should I use a pumice stone to clear away dead skin? Sure. Be careful.
- Do I need the crutches or the boot? No. I returned the crutches to Ann Naumann at Physical Therapy. She had replied to my post on GMBC-L in about 5 minutes with the offer of her crutches.
No barefoot walking.
Modify the Spenco insoles with a relief hole located by inking around the wound and stepping on the insole directly in the proposed shoe so it is properly located. That worked well. But when I hauled out some old New Balance 998s that had been in the closet, the outer sole separated from the body in a way that left granulated foam so that it was impossible to glue the sole back on. I looked on the New Balance site and found a lifetime replacement policy. I emailed this photo. We shall see.
Linda and I took our traditional walk around the neighborhood for the first time since the heart attack in December. That felt good.
Since then I have taken a couple of bike rides. One effect of the meds is that my hands stay cold after an half-hour riding, even if the air temp is in the 50s. But it feels right to be on the bike in time for Bike Month in May.
Thursday, April 9, 2015
Following Advice
I just saw again a funny video about advice. The woman has a nail in her forehead and the guy gently suggests that she take it out, but she just wants him to listen to her and not make suggestions.
Many of you have given me advice. Some of it is good. The podiatrist gave me very strong advice -- to stay off that foot. I should take it, but you know how it is. It is hard not to try to rush back to normal.
Muffet's advice: Write about it. Just start writing and see where the thoughts flow. They may wind up in a very different place from where you started. So, here goes.
Muffet's advice 2: Imagine a very visual block to your perfect happiness. It should be an image -- maybe a creature, or a black blot. Ask it to please move out of the way. I have tried this kind of mental imaging and it is helpful. The cognitive-behavioral approach is one of the only effective psychological interventions for getting through emotional problems. The VA uses such techniques in stress management of PTSD, and we can use them too.
After going through the mental exercize of picturing each part of your body from feet to top of head and relaxing each -- while conscious of your breath -- until you are quite relaxed. Imagine then that you are on a beach and you came there on a beautiful path through a woods and underbrush. Imagine looking up and down the beach and feeling the warm sun on your heart. "You can come here to your own private beach whenever you choose."
This is a brief description of the exercize we went through in Stress Management #5.
Podiatrist's Advice:
"Stay Off It." That's good advice, of course, but as I am finding through Stress Management, I have a lot of Type A behaviors. We aren't calling it 'Type A Personality' anymore, because that implies some rigid, fixed trait of character. Behavior is amenable to psychological intervention, such as relaxation and Mindfulness practice. In any case, my last visit to the podiatrist showed that the wound has almost healed. We can imagine an orthotic for bike riding which has a cut-out below the wound which will protect the newly-repaired skin and make sure that leg pressure goes to the ball of the foot, right over the pedal axis.
My challange is to deal with "time urgency." I need to be on time. This morning I made sure to get to Panera's to meet Duncan Admanson near 7:00. But I neglected to check the email correspondence which would have shown that we postponed the get-together until next Tuesday because I had an ophthalmologist appointment today. Executive function malfunction. Still, I was on time. "Time Urgent" is a description of another Type A behavior.
As is Shpilkes.
By the end of the Mindfulness session, I had modified my behavior so now I was sitting calmly and relaxing rather than stretching and bouncing around. Maybe I can follow advice once I see that it is addressing a pattern. I always thought I was pretty laid-back, but I do approach stuff in a compulsive sort of way.
Jonna's Advice: Exercizes from the back -- Air Bike and Ab Crunch. (Of course I will complain at the phrase "Lay back...") You really do get a workout with these.
Now I am in the long slog part of recovery and have been for a while; so much so that I haven't felt like writing about it, despite Muffet's advice. But this morning I had a cup of dark coffee, so I feel a bit energized, and here you have the followed advice.
Many of you have given me advice. Some of it is good. The podiatrist gave me very strong advice -- to stay off that foot. I should take it, but you know how it is. It is hard not to try to rush back to normal.
Muffet's advice: Write about it. Just start writing and see where the thoughts flow. They may wind up in a very different place from where you started. So, here goes.
Muffet's advice 2: Imagine a very visual block to your perfect happiness. It should be an image -- maybe a creature, or a black blot. Ask it to please move out of the way. I have tried this kind of mental imaging and it is helpful. The cognitive-behavioral approach is one of the only effective psychological interventions for getting through emotional problems. The VA uses such techniques in stress management of PTSD, and we can use them too.
After going through the mental exercize of picturing each part of your body from feet to top of head and relaxing each -- while conscious of your breath -- until you are quite relaxed. Imagine then that you are on a beach and you came there on a beautiful path through a woods and underbrush. Imagine looking up and down the beach and feeling the warm sun on your heart. "You can come here to your own private beach whenever you choose."
This is a brief description of the exercize we went through in Stress Management #5.
Podiatrist's Advice:
"Stay Off It." That's good advice, of course, but as I am finding through Stress Management, I have a lot of Type A behaviors. We aren't calling it 'Type A Personality' anymore, because that implies some rigid, fixed trait of character. Behavior is amenable to psychological intervention, such as relaxation and Mindfulness practice. In any case, my last visit to the podiatrist showed that the wound has almost healed. We can imagine an orthotic for bike riding which has a cut-out below the wound which will protect the newly-repaired skin and make sure that leg pressure goes to the ball of the foot, right over the pedal axis.
My challange is to deal with "time urgency." I need to be on time. This morning I made sure to get to Panera's to meet Duncan Admanson near 7:00. But I neglected to check the email correspondence which would have shown that we postponed the get-together until next Tuesday because I had an ophthalmologist appointment today. Executive function malfunction. Still, I was on time. "Time Urgent" is a description of another Type A behavior.
As is Shpilkes.
By the end of the Mindfulness session, I had modified my behavior so now I was sitting calmly and relaxing rather than stretching and bouncing around. Maybe I can follow advice once I see that it is addressing a pattern. I always thought I was pretty laid-back, but I do approach stuff in a compulsive sort of way.
Jonna's Advice: Exercizes from the back -- Air Bike and Ab Crunch. (Of course I will complain at the phrase "Lay back...") You really do get a workout with these.
Now I am in the long slog part of recovery and have been for a while; so much so that I haven't felt like writing about it, despite Muffet's advice. But this morning I had a cup of dark coffee, so I feel a bit energized, and here you have the followed advice.
Tuesday, March 31, 2015
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.
http://www.cartoonsimple.com/2
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.
Podiatrist.
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.
Handcycle.
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
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.
http://www.cartoonsimple.com/2
Podiatrist.
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.
Handcycle.
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.):
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]
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.
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.
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.
Subscribe to:
Posts (Atom)
