Updates on This and That

So many body parts are out of whack that it’s hard to know where to start.

Retina Tear:

A retina tear in the right eye was repaired by laser two weeks ago. Yesterday I was back for a follow up to make sure it was healing well (it is). It’s been hard to keep my head up when I have cats to tend and just getting in and out of my chair presents challenges. But I’m happy that what I was able to do was enough for the doctor to be pleased. I am feeling like a slug, though, after not doing NuStep or much else for two weeks.

Blood Clots:

I also had a follow up with the vein doctors about my blood clots, after yet another leg ultrasound 10 days ago. The scan report said I only had one chronic thrombus in the thigh and nothing in the calf, which didn’t match what the one done in the ER said three weeks before. But the vein people read the scan differently and said that yes, there is a second chronic thrombus in the calf. Apparently it’s not likely that either clot is going away but they will pare down to smaller little webby things on either side of the vein. At least that’s what I understood her to say.

I’m on blood thinners for life, which I expected. Xarelto is wicked expensive but so is Eliquis, which is the same medication class as Xarelto but you take it twice a day instead of once a day. That’s easier and I already have it, so we’re sticking to Xarelto. If I go to the dentist or need to have another kind of procedure, I’m to ask that provider what they want me to do about the blood thinners. Most times I can skip a few days without going into great risk, but a longer time off will require me to get a “bridge medicine” to take until I can take the Xarelto again. Whatever. I’m not to make assumptions or read Dr. Google for answers, but just ask the providers. When in doubt, need more info, or another clot appears, I’m to call either the P.A.’s cell phone or the general number and ask the answering service to page the doctor on call.

Shoulders:

The shoulders have been messed up for months from rolling the manual chair around. The TotalCare therapist who was here as part of the power chair process told me she thought I had rotator cuff problems which seems quite probable as I assess what hurts. Reaching hurts. Rolling hurts. Sleeping on my side hurts. Being attached to my body hurts. Inside the armpits hurts, too. My aide is giving me regular massages which hurt in a good way, and I’ve started going to Chair Yoga for stretches – but I have to be careful about my head position because of the retina tear issue. It may be time to go back to PT for shoulder help.

Miscellaneous:

I’ve had a deep chest cough for about three months. No fever, minimal drainage, facial pain. Splitting headache much of the time. Leg spasms. Right ankle that rolls. Left thigh has Meralgia paresthetica, a disorder characterized by tingling, numbness, and burning pain in the outer side of the thigh – another nerve thing that first popped up six years ago. It’s fun. Not. I’m off to the pain doctor next week and my mandatory 2-month drug screening because he gives me the good stuff. Although I have SI joint pain on both sides, I don’t think I can have an injection to help because of the blood thinner. But we’ll talk.

Power Chair:

All the paperwork was sent to insurance yesterday. We’re not sure if they will pay for the chair, since Medicare bought me the manual chair in 2022. But I have medical complications (think shoulders, ankle, blood clots) since then as well as weight gain. But the shoulders and blood clots are the big reasons they would consider it, plus my doctor advocated for it. I will pay for the power chair if insurance doesn’t, because it could be a huge improvement for me. We’ll see.

Medical Billing:

I have great insurance – Original Medicare A&B, with Plan G supplement, and Part D prescription coverage. Then I went to the hospital on January 1st, the day that deductibles zero out and you start again. My Medicare Part B deductible is $226 for 2023. The hospital bill was $20,214 plus assorted other physician billing for their very limited time with me. Okay, sounds good. Medicare A paid $1,600 of the hospital bill. Everything else is going to Mutual of Omaha for Part B coverage which restarted on January 1st. All of those claims hitting them at once meant that everything was initially denied since I hadn’t met my deductible. Except I actually paid the first of those bills ($208) on January 2nd using my cell phone. Since then I’ve paid $160 to the eye doctor and $680 to assorted hospital stay doctors. I know I’m responsible for $226 of the combo of things so someone is going to owe me a pot of money once they get caught up.

Not my eye!

I had two eye doctor visits this week for extra floaters and smeary vision on the right side (of course it’s the right side). It’s been like looking through a dirty windshield. The retina doctor confirmed this morning that I had a retina tear with fluid starting to come out – almost a detachment. Eeeeek! Scary!

He lasered the tear shut, describing it more as riveting in place. Those stinky floaters and “dirt” will take 6-8 weeks to settle, meaning dirty vision from one eye for up to two months. Booo. I go back in two weeks. Right now it feels as though there’s sand in it but my eye drops are helping.

I’m not to exert myself for the next two weeks, no lifting, keeping my head up. He said I should prop my head up with pillows to sleep but think I’ll just stick to the lift chair instead at least for the first few days. It’s amazing how often we look down to do things, including transferring from one chair to another. I’m not quite sure how I’m going to manage cleaning the litterbox and feeding the girls if I can’t look down to the floor. But I’ll figure something out and my neighbors will help.

I had a retina tear in the other eye thirty years ago in Boston (and how on EARTH could it have been 30 years ago? wasn’t that just a year or two ago?) so I shouldn’t be surprised that the other side wanted to have one, too. Add in cataract surgery with a YAG procedure correction and the eyes have been through a lot. But I really need them and will follow orders to keep my vision intact as long as possible.

I have a confession to make

I’d rather use the wheelchair than walk.

It’s not that I can’t walk; I can. I just prefer the chair even with the strain on my shoulders and wrist. I feel safer and can do everything I need to do, and feeding and cleaning up after Ellie and Emma are just easier when I’m lower to the ground and don’t have to balance.

Around the apartment I can manage with the walker, except I can’t wear the AFO’s to use the NuStep to exercise, and changing shoes all the time is a real pain. If I had to choose between walking and NuStep, the NuStep wins every time. It works my legs and upper body, plus I stand up all the time and do “dynamic standing” (which just means doing things while standing) multiple times a day.

I also am having problems again with the right ankle. Yesterday there was a lump the size of a golf ball just below and to the back of the ankle bone. It didn’t hurt and was probably fluid but it didn’t like being squished in compression socks and AFO’s. When I did walk, the inside of the ankle had sharp pangs of distress. I don’t think it’s sprained but what do I know. It might just not have recovered from a sprain I had a few months ago. We’ve been very careful with the right leg since it had a blood clot (now two of them).

I feel a bit like a failure preferring the chair to walking, but I know I can manage it safely on my own because I’ve done it for months. I will continue to do at least some walking but will try not to beat myself up for not pushing myself to do more.

New year, new blood clot

Instead of one blood clot in the thigh, I now have a second one in my lower calf of the same leg, which I discovered after going to the ER on New Years Day evening. The male PA poked my legs once, looked at a chart and at me, and said that he thought the problem was water retention, but that we’d do an ultrasound anyway just to be sure.

I was ready to sock him. I know the difference between edema due to water retention and edema from something else. The last time I had the same symptoms, they found a big chronic thrombus in the thigh after I complained long and loud that taking diuretics wasn’t fixing it. This time I also had sharp targeted pain in a specific spot on the calf and my foot was blown up like a water balloon.

And, when the ultrasound tech got there 3 hours later, she did indeed find another clot. She showed me the screen as she did the scan, which was cool. And gratifying. They decided to admit me but there wasn’t a bed available until 3:15am. I had a lovely private room and was there until discharge on Wednesday afternoon.

I saw the nurses when it was time for meds, and the CNA when it was time for vitals or when I pressed the Nurse button. I needed help to use the bedside commode. Well, actually, I didn’t need it once I asked them for a walker and to put the commode in front of my locked wheelchair so it was braced and stable. I could get my legs out of the bed by myself and finally figured out how to use a twisted bed sheet as a leg lifter to get back in on my own. I do this all the time at home.

My first day there was the Monday observance of New Years Day, which meant that doctors they needed to talk to weren’t working. I spent time watching TV, including many hours of Kevin McCarthy losing votes for Speaker, and reading reports of blood tests and doctor consults on the MyChart app. That’s how I learned the hospitalist had consulted with the vascular surgeon and the hematology/oncology people.

I also learned that all of these reports had a lot of wrong information because no one asked me the questions. I suppose the medical people think that all people in wheelchairs have problems I don’t have. I do not have urinary incontinence. I do not need daily assistance with Activities of Daily Living (ADL). I do not live in Assisted Living. I do not need a daily nurse visit. I manage my own meds.

A physical therapist came to evaluate me and was impressed that I could stand up on my own from the bed using the water. Dude, I’ve been doing that for 15 months. I stand up all the time. I couldn’t walk for her because I didn’t bring my AFO’s since my foot was too swollen to fit into my shoe when I left home. Mostly it was not a very productive visit – but at least I got to see someone.

The social worker apparently picked the exact same time as the PT to come see me. But instead of coming back, she called my brother who is my contact person. Tom pointed out that I was compos mentis and could answer her questions myself. Her report was full of wrong things that made me seethe. I don’t think any of them were that important but together it was just sloppy work.

One thing the doctors did get right, though, was admitting me as an inpatient and not for observation, something I asked about that first morning. I knew that there was a difference in how Medicare covered hospital admissions for those two categories. I was relieved when the doctor said I was admitted as an inpatient, which means that Part A covers the stay.

The hematologist finally saw me on Tuesday evening. He told me I need to stay on blood thinners for the rest of my life, which I had already figured out was probable because of my weight, the fact that I already had one clot, and the sedentary life I now live. Switching to Lovenox (with the shots in the tummy) isn’t a good idea, and switching to Warfarin would require regular visits to have blood checked to regulate dosage. That’s not as easy for someone who has to arrange for transportation for every visit. Xarelto is wicked expensive but it’s just a teeny pill that works the same as the others.

But I still don’t understand how I was admitted to the hospital with a second clot that developed while on Xarelto for 6 months and went home 4 days later with exactly the same problem and medicine. The vascular surgeons are going to monitor me and plan to treat it all with medication and not surgical intervention, so I have a scheduled appointment with them and another with my primary care doctor to get more blood work done (oh joy). It will also be my face-to-face visit required by insurance in getting a power chair. I have lots of questions for all of them.

ADDED: One good thing that happened, though, was getting a DNR prepared, witnessed, and is now in my permanent file at the hospital.

Recovery Year comes to an end

Discovering that my legs didn’t work was a game changer. It’s never something you expect or can plan for. I’ve worked hard both in rehab and out-patient PT to get back as much as I could. When I left residential rehab in October 2021, I gave myself through December 2022 to see how much mobility I could get back and how many real-life things I could do myself. I called it my “Recovery Year” even though it was actually longer than that.

I wrote out what happened so I would remember facts and emotions, and be reminded of progress through the hardest thing I’ve ever faced. I’ll keep doing that, but I’m going to widen my world to include more than just thinking about therapy and physical tasks. Because that gets really boring.

Some tasks are hard; others aren’t easy but I’ve figured out how to do them. And others that seemed impossible in the beginning are now parts of my normal life. There’s progress everywhere when I remember to look and to be grateful – and to continue that progress going forward.

First, though, I copied all of these “Therapy Notes” blog posts into 2 books, one for my intensive period (August-December 2021) and the second covering all of 2022. It feels productive and marks a turning point going into 2023. The books are only for me, something tangible to use for reference and remembrance.

This “Recovery Year” has been another game changer. Now it’s time to close this chapter and move on to whatever comes next.