No more hard cast

Late yesterday I called my doctor and told his nurse either they can remove the cast or I am going to.  I told them I have claustrophobic tendencies and this cast is really starting to get to me.  The first nurse I spoke to said don't worry it happens all the time.  The second nurse said if I take it off on my own they would document it.  I told her to document all you want but it's coming off.  They had us come in today at 9:00 to remove the hard cast and put me in a boot.  I called my brother last night since he had a similar surgery a year ago and he said he was never in a hard cast.  I asked the nurse why they didn't just have me go to the boot in the first place and she said Dr. Schwartz is very conservative and likes the hard cast on for 2-4 weeks and then puts the boot on. 

The one good thing is I was going to take the cast off the exact same way they removed it.  I told her I was going to take it off in such a way that I could duct tape it back on in order to survive until February 14th.  I am not sure I believe this but she told Huli and I that a man took a cast off of his arm with a circular saw that ended up costing him his hand.  I told her I was going to use a utility knife with the blade only exposed 1/8" so it would just barely go through the fiberglass cast.  I was then going to hinge the cast and then wrap it with duct tape.  She kind of laughed and said I had obviously thought about it quite a bit.

The boot actually seems to immobilize my ankle as much as the hard cast but it has straps on it so you can remove it if you feel the need.  Just knowing I can remove it allows me to wear it with no problem.

Jack

My best buddy and nurse

I was really hoping I would get my cast off and be able to start walking at my doctor appointment yesterday.  However that didn't happen and as it turns out I will be in a hard cast and not be able to put weight on my right foot at least until mid February.  My inability to be able to do certain things has added a lot to what Huli has to do to keep things going around here.  For example, she has been taking the dogs out by herself.  Normally this wouldn't be a big deal but since Tanner doesn't do stairs it means Huli has to carry him up and down the stairs of the motorhome each time he needs to go out.  This is something I would normally do if it weren't for my bad foot.  She has been a real trooper helping me get around, washing my hair etc. etc.  I told her when I get out of this cast I will make it up to her.  I told her I would buy her whatever she wants as a present but she says there is nothing she wants so I guess I will make it up to her by taking the dogs out and waiting on her hand and foot for a while to give her a chance to rest up.

Today the weather warmed up a little with highs in the mid 80's.  We spent the day at the pool.  Huli was in the pool while I was laying out in the sun in a lounge chair or sitting at the outside bar staying hydrated.  The problem with drinking while in a cast is having to go to the bathroom every so often.  I will say the scooter has to be a huge improvement over using crutches.

I have a tendency to be claustrophobic and I woke up this morning very early really upset over the cast on my leg. I had a cast on the last two weeks but it was soft on the outside and hard on the  inside so it gave me the impression that I could easily remove it if I wanted to.  This morning I started looking at the kitchen utensils to see what I could use to get this cast off before I finally calmed down and told myself to chill out.  I told Huli it's probably 50 50 that the cast will make it until February 14th.  If I cut it off I plan to do it in a way so I can put it back on with duct tape.  As long as I know I can take it off I am ok with it but knowing it's on my leg and I can't easily get it off really bothers me.  In fact,  just me writing this little bit about it has me worked up.  Right now I am telling myself I have all kinds of kitchen knives and other tools I can use to take it off if I want to get it off and this helps a little.  Just think I have another 16 days with this cast not that I am counting or anything.

Huli walked the dogs tonight and the no see ums tore her ass up again.  I still don't think I have been bit yet but I have not been out as much as Huli has been.

Post Surgery Visit and Clarification of my surgery

Well today I had my follow up doctor visit after my surgery.  Found out there was some misunderstanding between the doctor and Huli after my surgery as to what specifically was performed during the surgery.  After my surgery while I was in recovery the doctor told Huli he did not have to cut off my Achilles tendon.  Huli interpreted this to mean he shaved the bone off the back of my heel without removing my tendon which we found out today wasn't the case.  What he meant was my tendon was in very good condition so he didn't have to cut it off due to damage and make a second incision in my calf to get enough slack in the tendon to pull it down to reattach it.  They actually did resect it and then reattached it using two devices and bone screws.  Today my initial cast, bandages, and stitches were removed and a new fiber glass cast was reinstalled to keep my ankle immobilized.  I now go back on February 14th to get this new cast removed and will probably get an air cast at that time.  The good news is he said my progress to date is going perfectly since I have no swelling or any other complications like infections etc. after the surgery.  My only problem is I  am still not suppose to put any weight on my foot but at least I don't have to keep it elevated as much like I have the last two weeks.

Still chillin,

Jack

One week after surgery

Well it's been a week since I had my heel surgery.  I quit taking any pain medications last Monday morning three days after my surgery.   As it turns out the pain pump they sent me home with didn't starting working until Sunday.  The way the pump is suppose to work is like this.  When totally full the pump is the size of a softball and is under pressure.  It is filled with liquid which is the pain medication.  The ball is suppose to gradually reduce in size as the medication is being released into my leg .   It should last three to five days depending on what setting you have the pump set on.  At the highest setting of 14 it should last three days and at the lowest setting about five days. The ball didn't change size until Sunday.  The first couple of days a nurse would call and I would tell her the ball is the same size.  She had us look for kinks in the line etc. but we couldn't find any.  On Sunday I squeezed the ball real hard with my hands and I think that must have broke the obstruction loose since it started getting smaller after that.  On Monday morning I took the pump off and stopped taking pain pills and have been fine since.

Yesterday, Wednesday,  Huli took me out for lunch which is the first time since I got home from surgery that I have been outside of the motorhome.  We added about 30 premium channels to our Dish network package the day before my surgery so I spend a lot of time watching tv and on the computer. When your in pain or don't feel well staying inside laying around keeping your leg up is easy.  After three days I wasn't in any pain and started feeling pretty good so the laying around with my leg up has been a real pain the last few days.  I go back to the doctor Monday so I hope my cast will be removed.  I would think that once the incision site is healed up that I would be ok to walk since my Achilles tendon wasn't cut.  I wouldn't think removing the bone would require much healing before I could walk on it.  I guess I will find out Monday.  One good thing about when I had my surgery has been the weather.  We have had much cooler weather since my surgery.  The highs have been in the high 60's to low 70's most days.  Since I am in a small confined space and spend my time with my foot up it's been easy to get around using my knee scooter.  We had a walker too but took it back since I didn't need it.

Our neighbors Jim and Patsy have made us a dinner and a lunch since my surgery.  Jim made us veal for dinner with mashed potatoes and asparagus.  For lunch he made us vegetable soup.  Jim loves to cook told us this is what they like to do for people they like.  He doesn't cook just plain things but seems to enjoy doing the out of the ordinary dishes.  He has a grill and oven set up in front of his motorhome where he will cook when the weather is warmer.  Then they usually have people over about once a week and they just sit outside at their table and drink wine and then eat dinner.  One night they drank so much wine and were having such a good time they forgot to eat dinner.  Usually after dinner they will drink some more wine and Jim will fall a sleep at the table.  He'll sit there and Patsy will talk about him until it's time for their guests to leave. For people in their mid 70's they still have a lot of fun and seem to really enjoy life.  They are great neighbors.

Below are a couple of pictures of my cast and knee scooter.  The first few days I was in bed in the living area of the motorhome.  First I was on the jack knife sofa and then I switched to the hide a bed with the air mattress that is in the other couch.  Now I am sitting up with my foot up on the couch usually on a pillow to keep it elevated even more.

These little scooters make getting around very easy.  I have never tried crutches but imagine the scooter would be a big improvement over crutches.  This one is rented from a hospital supply type store.



Day One Post Operation

We had to be at the hospital yesterday at 7:00 am to get ready for my surgery which actually got under way at about 9:20.  Leading up to the surgery I spent a lot of time finding the correct doctor/surgeon.  My doctor was an Orthopedic surgeon who specialized in foot and heel surgeries and sports medicine.  I wanted someone who was going to get me back to being active not just getting be back so I could just get around without pain.  I didn't do anything to pick the hospital since this is the only place in Fort Myers that falls within the Aetna network.  My doctor does perform surgeries at a surgery center but unfortunately this was not in the Aetna network. During my research finding a doctor many people tried to persuade me to not have the surgery at Lee County Memorial hospital.  I later found out why.  The hospital was just not the caliber that hospitals were for my previous six surgeries.  It wasn't just one thing but everything.  I hope I am not sounding like some snooty asshole because believe it or not I rarely complain even when I receive bad food or service unless it gets really bad.  I did have several nurses and others who were great but the overall treatment I received was by far the worst of my now seven surgeries.

The one thing that was great was my surgeon.  My surgery lasted just over one hour and he was able to remove the bone on the back of my heal without having to resect my Achilles tendon.  He would not even let me know this may be possible in the office visit since the likely hood of being able to do this was very low.  When Dr. Schwartz spoke to Janet after my surgery Janet said he was almost giddy in describing the results of the surgery.  He said my tendon stretched over the bone deformity but snapped back into place once the bone was cut down and removed.   He told Huli it was the largest Haglund's deformity he had ever seen.  I hope after recovery I will be able to walk and do other things without pain. 

After the surgery we were on our way at around 12:30.  I climbed into the back seat and away we went.  I have a pain pump about the size of a softball that runs to my sciatic nerve in my right leg.  This is basically a ball full of narcotics that is under pressure with a regulator attached that lets you dial up your pain relief between 1-14.  I have left it on 8 even though the nurse said I should turn it up.  My strategy is to keep it at the lowest level where I am still comfortable since it will last longer
that way.  If you leave it on 14 it will be depleted much faster than leaving it at eight.  I also take pain pills every six hours to cover other areas of the surgery that the sciatic nerve pain pump doesn't cover. I am laying down on day two of ten where my toes are above my nose for 23 out of 24 hours per day.  So far so good.

I want to say Thanks to everyone who wished me well.  I know I will be up getting around in no time.

Jack

Thursday is the surgery but today the real extraction began

We went to the Lee County Memorial Hospital in Fort Myers last Friday so they could do some blood work and an ekg to make sure I had a chance of surviving the surgery.  Before the visit we called to find out about the estimated cost of the surgery and if we could prepay the bill for a discount.  This is what we have done in the past which saved us 25% of the bill.  The person we spoke to on the telephone said they would ask us for payment and would go over the payment options when I had my preop testing done.  When we registered for the preop tests no one mentioned us paying anything.  While I was having my ekg done Huli went down and ask them about payment options etc.   The lady at the desk said they don't handle that here and we would have to call an office in Cape Coral, Florida to find out about that "stuff".  Huli called the Cape Coral office today and the guy answering said he had no idea why we would be calling him.  When we explained we were given his number by the preop registration people he just laughed.  He said he would have someone else call us later today.

This evening Gabriel Sanchez called me and ask me to pay an $8,400 initial payment.  I ask Gabriel if I paid the entire bill now would he give us a discount.  He said we already got a discount since the procedure originally cost $35,000 and they discounted it to $21,000 for Aetna.  I said that is great now he gave us the same discount he gave Aetna I would be happy and would pay the entire estimated bill now.  He said no he couldn't do that.  He then started explaining I had a $7,900 deductible and a $12,500 maximum out of pocket and then I stopped him.  I told him I fully understand how deductibles work but for them to discount the bill to Aetna 44% won't save me one penny when I get done paying the hospital, anesthesiologist and the surgeon bills.  He didn't understand that so I explained in terms he understood.  I said let say you wrecked your car and the damage was $5,000 and you have a $1,000 deductible policy.  Assuming no discounts are given you would have to pay $1,000 while your insurance company would pay $4,000.  Now I said the body shop was having a huge sale and the $5,000 damage was being discounted to $1,500.  I ask him if he thought it would be ok if he was still asked to pay $1,000 while his insurance company paid $500.  He said no.  I said I didn't think so either and I want the same deal you are giving the big corporation Aetna.  He gave me his managers name and number and his directors name and number.  He honestly said he never thought of it that way and I told him I never had a hospital tell me they wouldn't give me a discount for paying the entire estimated bill in full the day of the surgery.  I told him don't worry about it though since the surgeons nurse never had anyone ask her if the amount the surgeon charges for my procedure falls within the usual and customary as defined by the Aetna Insurance Company.  This was after she ask me 20 questions in order to determine if I had the money to pay them since I had such shitty insurance that only costs me $1,850 per month in premiums.

Huli and I later did some digging and found some mention of 25%  "prompt payment discounts" on Lee County Memorial Hospital's website on uninsured balances.  I will find out tomorrow when I call the Director of Business Affairs.

As Sy on Duck Dynasty says "It's on Jack".  I actually kind of like doing this kind of stuff and have often thought I could start a business negotiating medical bills on behalf of other people and then maybe loaning them the money upfront to pay the bills.  After receiving some kind of collateral of course.  Then again that kind of sounds like work.  I should mention Huli helps a lot with her background in dealing with medical billing for several years. 

Day Trip to Naples and the Big Cypress National Preserve

Today we decided to take a day trip to Naples and the Big Cypress National Preserve which is in the everglades of Florida.  In Naples we spent our time driving around near the beach looking at some of the homes in the historic district of the city and just kind of checking things out.  The houses were over the top but I particularly liked the landscaping around the houses.  The variety of plants and trees you see in this part of Florida is just amazing.  

One thing that surprised me in driving around Naples was the amount of new houses being built in these very wealthy old neighbor hoods.  Everywhere you looked a brand new house was under construction which first required tearing down an old house, probably valued at several million dollars, that originally stood on the lot.  I have heard on political and financial shows that the gap between the rich and middle class has widened significantly over the last 20 years.  I guess this kind of supports the super rich are doing pretty good. 

After seeing the manatees, birds and some alligators at the preserve we stopped at the only restaurant/bar in around 50 miles in any direction.  They had live music cold beer and a good vibe  around the restaurant.  I had the assorted seafood platter that included crab claws, grouper,  and shrimp.  Huli ordered the crab cake sandwich and then we shared.  The food was only so so for the price but the atmosphere and the people working at the place were great.

This was probably the last time I will do much sight seeing before my surgery next week.  I am ready to get it over with so I can start the process of recovering.  The reason I have put this off for so many years is due to the recovery time with this procedure.  I told my neighbor I would rather have a hip and knee replaced instead of the Haglund's deformity surgery I am going in for.  It is not uncommon to have swelling that lasts for 10-12 months after surgery.  I will not be able to put any weight on my foot for at least a month not to mention the first two weeks after surgery being spent with by foot above my heart for 23 out of 24 hours a day.  Oh well in the end I hope I will be able to walk normally without any pain.  That will make it all worth it.

Here are some pictures of our trip today.  There probably isn't a house in any of these Naples pictures that would go for under $10 million.  This area of Naples is one of many where the really wealthy live. I like the character of these houses and the properties surrounding them.  You also saw a lot of people out walking and riding bicycle's.

I was told this is a papaya tree

 We started outside but moved inside closer to the music.

My kind of place.  The one unique thing about this place is you help yourself to the beer that is in either the refrigerator or in one of four coolers sitting on the floor.  You keep your bottle caps so you can keep track of how many you drank when it comes time to settle the bill. 

This guy must have watched too many Crocodile Dundee movies.  It's hard to see but he has a knife about 14 inches long strapped to his right side.  It's the kind that has finger holes in the handle.  This is the refrigerator where you just help yourself to the beer or other drinks.

 

 There are several times in my life when I wished I would have known where this store was located.

 Doesn't every bar have a stuffed owl hanging from the ceiling.

If not an owl how about an alligator head?

 

 I will never order crab that comes in these little claws.  Too damn much work for the little bit of meat you get out of them.  The grouper and shrimp were very good though.

Huli hard at work playing dice with friends. 

 

 A small portion of a wall of pictures of people who are much prouder of their bodies than I am.

Yes, I take my camera to the restroom since many times that is where you see the best "sayings" or pictures. 

One day I should publish a book with just stories and pictures I have taken from the hundreds of bars I have been to in my life.  I wished I would have started taking the pictures earlier since I didn't start doing that until later in life.

If not the smallest post office in the U.S. it has to be in the running.

 

 



Saw the Doctor Today - My surgery is January 16th

I went to see the orthopedic surgeon today to see about getting my right heel fixed permanently.  For those who don't know I have about one half of a golf ball bump on the back of my right heel.  I have had this for many years but it just started really impacting my mobility in the last few months.  I have been in pain just walking the last few months.  I have had some degree of pain for many years but have been able to just deal with it.  I have been to a podiatrist and to my regular physician who said don't mess with it because of the rehab involved with the surgery.  The pain is getting so great it has effected my ability to walk so today I learned what I already knew needed to be done.  They will resect my Achilles tendon and cut the bone off the back of my heel and will then reattach my Achilles tendon using four screws and an attachment device.  The surgery will last about an hour and will be done on an outpatient basis but sometimes turns into a day or so stay.  After the surgery the fun begins.  For the next ten days to two weeks I need to have my foot elevated for 23 out of 24 hours each day.  If I don't do that my foot will swell up like a watermelon and the recovery time will be increased exponentially.  Huli said she is ready to be the trooper and take care of me during this time (since we were teen agers she has always been there for me when I needed her).  We are getting walkers and knee walkers lined up so I can get around after the surgery.  The key is we need to get the motorhome headed north to Indiana the first of April.  My doctor, Jeremy, thinks this can happen with no problem but he stressed keeping my foot elevated 23 out of 24 hours for the first couple of weeks after the surgery.  He said swelling is the biggest problem with this kind of surgery.  Janet is pleading with me to do what he says and I plan on following his directions to the letter.