My leg is screwed

Last week when I visited with the orthopedic surgeon she gave me a bit more information on what she did, or more accurately what she inserted into my leg.  I have a device called a ‘sliding compression screw device’ in my right femur.   The ’screw’ helps to hold things together while limiting direction and speed of motion.  Apparently one of the strange feelings I have from the leg is the compressive device limiting how fast parts move in relation to one another.

On every visit to the orthopedic surgeon she points out my arthritis.   That is something I’ve known about for close to two decades.  Perhaps the reason she is pointing it out is to prepare me for one possible side-effect of the injury repaired with the ’screw’:  “over one third of patients w/ RA treated w/ a sliding hip screw (for intertroch frx) will sustain a major complication (AVN, nonunion, loss of fixation).”  AVN is avascular necrosis, or for the benefit of cyclists we will just refer to it as  ‘Floyd Landis syndrome’.   Here’s hoping that I am in the under 2/3 of patients with RA who do not suffer these complications.

Then there have been my own horror story experiences with doctors.  When I contracted malaria I knew what I had, and I conveyed that to my primary care physician.  The problem is he did not want to believe me and instead chased diagnoses of other exotic diseases (meningitis, encephalitis, and others) all the while failing to order the simple blood test that would determine whether or not I had malaria.  That was close to being a fatal mistake.  Finally my complaining resulted in a new primary care physician being assigned to me and  within hours we had a confirmed diagnosis and treatment started.   Then there is the case of my sensitivity to oats.   I knew something was wrong and I conveyed the physical symptoms to the physician.  He found anomalies in the blood tests,  also, but did not want to consider that it all might be food related.  Many, many tests later, looking for all sorts of exotic causes, the physician more or less gave up and told me to live with it.  So I started my own ‘process of elimination’ food testing and eventually came to discover that oats were the culprit.  As soon as I removed oats from my diet the physical symptoms went away and my blood composition returned to a more ‘normal’ state.

For the last few years I have been trying to put aside my past biases and to work with my physicians.  And that is what I was doing with the orthopedic surgeon in regards to my hip.  I have followed her orders, so far, to the letter.  But now it is time for me to consider going outside those bounds.    I was content until yesterday when I learned that she did not want to give me the extra leash I think I can use.  All I asked for was a referral for Physical Therapy.  I am progressing well, and think that I could use some help to guide my recovery.  But the orthopedic surgeon says no, and that if she decides I should have PT that decision will come after my next visit … 5 weeks from today.  Note that she may still decide against it, and from the tone of her message I take it that is a distinct probability.

So now it is time to go against doctors orders and to see about starting on a physical therapy plan.  A friend who is a DPT suggested the exercise I did in the swimming pool on Monday, and she is coming by tonight to assess my ‘walk’ (as it is) and to determine what I need to work on to get to the goal of walking without aids (crutches/canes/etc.).

There are times to be compliant and follow directions.  And there are times to decide that perhaps there are alternatives.

The first bill I have received is from the hospital for my treatment in the ER (but not for the trauma doctors, all billing separately), the operation (but not the surgeon), and my 61 +/- hour stay.   The total is tickling, hard, the six figure range and some of the charges seem a bit excessive.  The 30 min or less with PT on my second day, basically them watching me get up and hobble on a walker then crutches, comes in at a bit over $500.  The OT person who followed along but did not really do much other than say ‘good job’ is apparently worth almost $700.  The PT person the next day, the one who took me for one lap of the floor and a couple of steps, is charged at $600.   There is a full body CT scan at $25K, and a separate head CT scan at $5K.  Isn’t the head part of the body?  Couldn’t they do it all at once for one price?

The craziest part of it all is how the numbers change due to my insurance.  There is a ‘contractual adjustment’ to the near six figure price, an adjustment that deducts 80% of the price from the total, with the remainder being allocated to the insurance carrier and to me.   Which is a bit scary; if I am John Doe without insurance I would be on the hook for nearly $100K just for the hospital, but since I have insurance yours truly and the insurance company together only have to come up with 20% of that amount.  Now that is truly ‘Sicko’.   And it really points to the need for healthcare/insurance reform with universal coverage.

• Ankle: pretty much destroyed in one of those ball sports back around ‘67, reconstructed in ‘68.
• Knee: off and on damage over the years, possibly more in the latest incident.  Will have X-rays and an assessment made in a couple of weeks.
• Hip: in the recent accident the hip end of the femur needed to be reconstructed using traction and a ‘box of hardware’ according to the orthopedic surgeon.  Interested to see the X-rays next week.
• Shoulder: definitely messed up after the recent accident.  So far the orthopedic surgeon has ruled out rotator cuff damage, but nothing else.
• Elbow: hey, no damage.  Yeah!
• Wrist: pretty messed up  when I was presumably drop-kicked by a car in 2002.  Have an “L” shaped titanium plate and 6 screws holding it together.

The left side has been relatively free of damage.  Some minor damage to the knee, and broken ribs from a car accident, but no joint reconstruction.  Perhaps I need to add additional padding and protective material to my right side?

For those not keeping up, I took a spill at Hellyer Velodrome on Wednesday night, leaving a fair amount of skin behind (nose, upper lip, both knees, both elbows), getting a fair bit of bruising (right ribs, shoulder, and knee), and breaking the end of the right femur. The femur has a hip screw (large screw into the ball of the femur), two plates, and several additional screws that were added on Thursday. I am one messed up guy.

The biggest thanks has to go to The Wife who has been doing yeoman’s duty helping out under what are, for her, difficult circumstances. She has such a tenderness to her heart and soul that it is hard for her to help me at times since helping causes some momentary pain. She fights through and has been solid in doing what she can, and more, to help me get around for now and repair so i can become independent again. I can tell how hard it is, and sometimes my pain may come across as grumpiness, but I can assure her that I appreciate all she does and I am working to keep my comments to myself. Thanks sweetie!! I can never repay in full, but I will work on that debt later.

Also a big thanks to those who helped at Hellyer and assisted in getting us to the hospital. I was pretty much out of it; I remember the start of the race (BxC points race) and I remember someone telling me to wait for the ambulance, but other than that my memory banks are blank until such time I was in the CT machine at Regional Medical Center being scraped along the wall of the device by incompetent techs.   Major thanks to Rick Adams, and to Michael and Sabine who helped to gather my stuff and get it to the Toaster along with the newlyweds Erika and Linda who continued to help transporting the Toaster to the hospital for the wife, learning my full legal name in the process.

A big thanks to the staff of Regional Medical Center who worked fast to get humpty-dumpty together to the point that I was able to go home about 64 hours post accident. And to the dozens of folks whose calls, e-mails, and blog posts have conveyed good wishes.

And a special thank you to the friends who have taken some of the burden off The Wife by offerering to plan, prepare, and drop off meals to keep us nourished, thereby relieving The Wife of that extra task

If I do not get a chance to extend the thanks in person, know that I want to and I greatly appreciate the tasks of the many.

The road rash from the crash in the Memorial Day crit is rapidly healing. The worst spot is on the back of the left hand, which was itching up a storm through the night and resulting in me throwing in the towel and getting out of bed at 4:37AM (uggh!) since I could not sleep. Still a bit of bruising, but that is fading. All of the bodily parts seem to function.

Last night the Colnago was restored to some semblance of working order. The shifters are on and seem to shift fine. I wrapped up the bars, trying the fi’zi:k tape made of Microtex. Not sure about how it will feel or wear, but it is a pain to work with. Only thing that I have used that is more of a pain is the Brooks leather bar wrap.

This weekend I plan to get out and see if the body and bike will be up to the 47 mile Pescadero Road Race 8 days from now.

Today was day 2 of the annual race weekend put on by the club. I spent yesterday working at the finish line of the Mt. Hamilton Road Race, opting out of the logistical headache of getting from Livermore to Isabel Creek and back, in order to race today at the Memorial Day Crit in Morgan Hill. The plan was for me to cheer on the Cat 3/4 women, do my warmup, race in the 45+ 4/5 field, then work for a couple hours of course marshal and ride north towards home. At least that was the plan.

And the plan worked, up to a point. And that point was to about the 12 minutes left mark in our race. Things had been a bit sketchy a couple of times, notably some wheel dueling on the nice sweeping curve between turns 3 and 4. Coming into the very wide and nice turn 4 I was towards the right side of the field on a right hand turn, marking my inside guy as we came into the turn. Then about halfway through the turn someone came around me to the outside and dove in hitting my front wheel, I spun towards Mr Inside Guy, bounce back to the outside to hit Mr DiveIntoTheTurn …. and eventually I could not get it under control and went down. Fortunately it was solo. Unfortunately I have a nice bruise and road rash on my left hip, left hand, left elbow, right elbow, and right knee. And my helmet is toast, as are the gloves, my bib shorts, and left shifter. The jersey might be worth salvaging.

Thanks to Andrew, Joe, and Benson who came to help within seconds of the crash, and EMT Katherine who assessed the damage then cleaned and dressed the wounds. And to The Wife a big thanks for everything you did to assist, and all you will do over the coming days. And a big apology for not coming out clean.

* P.S. Apparently the fun continued; there was a crash in the very next turn. Can’t help but wonder if it was the same over-aggressive corner diver.