Hands Down

Do you have two hands that work?

If no, you have my deepest sympathy.

If yes, I suggest you put one of them in your pocket or behind your back.  Got it?  Good.

Now go wash your hair.

This has been my life since the summer of 1993, on and off.  Mostly on.

I’ve had four hand surgeries since then: three on my left and one on my right.

I won’t elaborate on the proximate cause of the situations leading to these surgeries.  I may finally get around to editing and posting the story of Costa Lotta Jack, the evil Appaloosa who tore my wrist bones apart back there in ’93.  Now is not the time.

Let us begin with the premise that my left wrist was destroyed in 1993 by an evil Appaloosa named Costa Lotta Jack, which lead to my first wrist reconstruction a few months later.

That repair worked so well that I was able to relearn to play the banjo and fiddle.  Not the way I played it before: I lost a lotta wrist action in that fight.  Good enough to cut a solo CD that still tops the folk charts, although it still hasn’t paid for itself.

Six or seven years later, that repair broke down.  Another reconstruction.  Lost some more range of motion with that one, but managed to keep playing music once they pulled a couple of steel pins out of my wrist.

And so on until a year ago, when I had a big crash and burn from tripping over a barrier between two campsites in the pitch black new moon dark.  The hand surgeon in Flagstaff was sure it was a tear in the joint capsule, and the MRI with contrast demonstrated the same.

And by the way, my shoulder started hurting then.  And it seemed to have jolted something loose in the minefield otherwise known as my neck.

So began my love affair with Flagstaff, Arizona, home of many orthopedists.  Hallmark of a ski town.

I got tired of running to doctors after awhile, and decided that some benign neglect might do me some good.  Or you might say I was sick of hearing that I needed this operation and that operation.  Really burnt out, if the truth be known.

Off I went, tending to this and that family emergency.  My wrist and shoulder and neck still felt bad, but not as bad as running to doctors.

When I landed in Tucson for the winter, it made sense to make friends with a local orthopedist about my shoulder, and with a hand surgeon about my wrist.

I had my initial consultations taken care of, and a return visit to the shoulder guy for an injection into my subacromial bursa, which is a fluid filled sac in the shoulder.  It didn’t help.

Then, toward the end of January, I had a terrible fall that tore the shit out of my rotator cuff and did something bad to my wrist.

I went immediately to the hand surgeon, who scheduled surgery, and to the shoulder guy, who sent me directly from his office into the nearest MRI machine.

The MRI shows two full thickness tears in my rotator cuff muscles.  As a bonus, I split the tendon to my biceps muscle in two.

But I’m getting ahead of myself.

I had my latest hand surgery 8 days ago, I think.  I’m still a bit addled from all that has gone down, so if I get things out of order, that’s why.

I’m told that the surgeon came and talked to me after the operation.  I can’t remember anything, because I was waaaaaaaaay over-anesthetized.  That can happen, especially if the anesthesiologist doesn’t listen when you tell them there is a very big reason you resist general anesthesia.  Some of us need a much lighter hammer.

I had rented an Airbnb room in which to recover for a week, boarded Atina the Doggess, and settled in with my vaporizer and edibles (I don’t do well with opiates).  I hired people from a local home health agency to drive me to the surgery and back and go to the pharmacy and Trader Joe’s for 24 bottles of Trader Joe’s brand seltzer water.

That night, or maybe the following night, I got two phone calls, one from each of my guys.

Shoulder guy: “Well, you have two high grade tears in your rotator cuff muscles, plus your biceps tendon is split.  Other than that, your MRI looks great (except for the rough place underneath another muscle that shows it is getting squashed by something else).  You should be able to put off surgery for a few months…provided you don’t fuck it up again in the meantime.”

He didn’t use those words exactly, but that’s what he meant.

Next call was my hand guy.

“Um, how are you feeling?”

“Just peachy.  What did you find in there?”

Pregnant pause…then he said:

“Oh sweetheart….”

WTF, my surgeon is calling me sweetheart, and I want to know why.

“I’m so sorry.  I thought we were just repairing your joint capsule, but when I got in there with the scope I found that your triquetrum (one of the 8 bones in the wrist) was rattling around loose in the joint, no ligament, no cartilage, no blood supply…so I had to take it out.  Really should have done a first row carpectomy (procedure that removes a whole row of those little bones because once they’re fucked up they don’t heal), but I didn’t have a permission signed for that.   We’ll have to watch this carefully and maybe plan that operation for the future.”

Instead of bawling, I said (with considerable irony),

“Well then.  I suppose I’d better sell that new guitar.”

“Oh, no, no, don’t sell your guitar!  We’ll get you back playing!”

Nice one, Doc, but I’ve been around this block a whole bunch of times.  I didn’t fall off the turnip truck yesterday.  I know as well as anyone else what happens when you start taking out bones.  It’s a slippery slope.

I Got Carded!

And the good news is, I got carded for the first time in 32 years.

The State of Arizona, otherwise notable for refusing Daylight Savings Time, and for the Grand Canyon, and Tombstone, and Prescott, all splendid ideas–has seen fit to award me my Medical Marijuana card even though I’m not **yet** an official resident.

I think they took pity upon my sorry ass.

And they knew I needed it, because I am in a world of hurt.

My appointment with the Hand Surgeon arrived today.  I got to wait two hours, then saw his PA, who had filthy fingernails.

I find that utterly repulsive.  A health care practitioner MUST have clean fingernails.  Hell, I’m sure Doc Holliday had clean fingernails, even though he was a drunk, a gambler, and a sometime outlaw.

I even clean my own fingernails before I go to a doctor appointment.  When I was in practice, I not only cleaned them every morning before heading to the office, but also used a white nail pencil (which I have not seen in stores for years) under the tips, to clean them further and make them shine.

The PA was not in my life for long, however, as she took immediate note of the way I flinched and yelled “Ouch!” when she pressed on the place where it hurts.  I made it easy for her by showing her the place.

She left the room and returned with the actual hand surgeon, a very nice young man.  He extended his hand, I rose from my chair and shook it, we introduced ourselves by our first names, and he complimented my last hand surgeon on his fine handiwork and inquired how it was done.

“Pins,” I told him.  “He pinned the hell out of those little bones and told me never to move my wrist again.”

He laughed.  But that is true. 

Of course the surgeon had to manipulate my wrist some, just to get his own idea of what is fucked up wrong, so hours later the bitch is still throbbing.

Predictably, he ordered an MRI.  As a bonus, we’re going to have an arthrogram with our MRI.  Half an hour prior to the scan, he will inject some contrast material into my wrist joint, and the MRI will show where the stuff goes.  This will clarify what is ruptured.  I think I know.  I’d make a bet with my doc, but I think we’re both on the same team.

So, after getting all the paperwork done I walked out to the parking lot, stuffing down a scream, and let the Biggess Doggess out to pee.

Aha, there is my phone!  I knew I left it somewhere.

Three messages from the spine institute in Denver (thank you, friend who suggested this!).  Two of their spine surgeons have reviewed the imaging studies I sent them, and both are of the opinion that I need “decompression and fusion at two levels (of my neck)”, just the same as the spine surgeon here in Flagstaff. 

I guess I will be having a busy spring.

It’s hard to do this kind of shit all by myself.  I wish I had the money for hotel rooms and private duty nurses.  I don’t, so there will be some sort of arrangement with hospital security so I can stay in my van in the hospital parking lot for the hand surgery.  The spine surgery recovery will have to be in some rehab facility, ick.  And poor Atina will have her first boarding experience.  Ever since I’ve had her, she’s been with me every single night, even after her own major surgeries.  It will seem really strange not to have her with me, but since I won’t be able to care for her, I guess that’s how it has to be.

It was getting late by this time, so I drove back to the campground, still suppressing screams.  It upsets Atina terribly when I scream.  So I rubbed her head and ears all the way back, driving with my solidly braced up bad hand.  One thing about having a lot of orthopedic injuries, you get pretty good at bracing and splinting, and at driving with one hand.

Back at the old campground, I rummaged in my stash bag and found a strain of legal (I have my card, remember) cannabis called Blueberry Trinity, which I imagine might be named for the “Trinity” nuclear fission experiments.  Whatever.  I inhaled its vapors, then set to work on a few shots of whiskey.  No, not the best coping mechanisms.  Fuck a bunch of coping mechanisms.  I needed oblivion.

The phone rang.

It was my old boyfriend and now for 18 years telephone friend Dick!  That’s not his actual name, but I know he won’t mind.  I spilled my guts to him, which was just what I needed.  He must have got “the vibe” that I needed help!  We talked all the way through his dinner.  His wife put up with it gracefully.  She is a graceful person, and I’m very glad they have each other.

Now the intoxicants have pretty much worn off.  It’s time for Atina and I to take our pills and go to sleep.  She’s lying up against me, upside down.  I’m intermittently rubbing her tummy.  Guess I’d better take her out for the last pee of the day, and call it a night.

Phantom Limb Pain

There’s a crazy phenomenon that sometimes happens when a person loses a limb. The nervous system thinks the limb is still there, so that the person continues to have the sensation of having it.  I mean, to the point of the former owner freaking out because they want to put on a sock because the foot is cold, but the foot persists in not being present.  This is called a Phantom Limb.

But since the limb has really been amputated, the limb also feels the pain of that, and of the injury or disease that lead to the amputation.  This can become a terrible situation if the limb doesn’t get used to being amputated and settle down.  How can you relieve the pain of something that doesn’t exist?

I just realized that I am suffering from Phantom Limb Pain.

Some of my readers know that I am caring for my beautiful Belgian Malinois, Atina, who is dying of kidney disease.  She is now 19 months old, and starting to slow way down.  I’m enjoying her delightful self for now, and I will take care of her until it is time for her to go.

I just received the final pathology report.  It is terrible.

For those who don’t toss around medical terminology on a daily basis, let me give you your word of the day:  nephron.

A nephron is the basic operating unit of the kidney.  It has three parts, which all have different essential tasks in maintaining the balance of fluids and electrolytes (like sodium and potassium) in our bodies.  In addition, special cells called podocytes keep our serum proteins from leaking out.  These are the parts of the kidney that maintain fluid and electrolyte homeostasis, in a delicate and incredibly intelligent system of checks and balances.  Any disturbance of kidney function can lead to a disruption in the system, depending upon which area of the kidney is damaged.  And that can lead to illness and death.

Atina’s biopsy shows that 90% of her nephrons are fetal, which means that kidney development was arrested before three weeks of life.  The pathologist writes that this could be due to disease or toxins being transmitted to the pup through the mom’s milk.  The remaining 10% of normal nephrons are becoming ballooned out of shape from having to process all that pee by themselves, and their podocytes are starting to detach, which is why her urine is full of protein.  Soon those few functioning nephrons will die, and then Atina will die.

I stopped by the vet’s yesterday for another reason, and just for kicks had Atina stand on the scale.  She’s gained three more pounds…of fluid.

When I first got her, she weighed 55 pounds of skin and bones.  She looked like a sick cow.  With treatment and lots of love, she put on ten pounds and was looking and acting like a normal, healthy, happy, bratty adolescent Malinois.  I started her in Service Dog training and she was doing great.  I had this spark of hope…

Then she started looking weird and puffy.  Despite treatment, her blood pressure was sky high (another kidney function thing), and she went back to drinking gallon after gallon of water, and peeing like a waterfall many times a day, and even needing to go out at night sometimes.  And her weight keeps creeping up, and her appetite keeps slowing down…

I’m glad she’s with me, and that I’ve had the honor to be her very own human and caregiver, friend and mutual aid society.  We are passionately in love.  She’s asleep now, but if she knew that I am crying she would rush to my bed and throw herself on top of me, causing various injuries.  Since I know that they are love bites, scratches, and bruises, I take them in the spirit in which they were inflicted.  And once her initial exuberance settles down, she cuddles and kisses and lets me cry in her fur.

Aside from the love injuries, I have been injured in many ways since becoming Atina’s personal angel.

I needed a service dog to guide me through the next ten or so years of my life.  Instead I got a very sweet invalid dog, with whom I fell in love, from whom I will be parted very soon.

This beautiful sick girl of mine cost me $12,000 up front, and more than $10,000 in medical expenses so far.  I have used up most of my financial and emotional resources, and at the end of the day, I won’t have a dog, and I won’t have the money, and since even now I keep myself alive by force of will, Atina’s death may sever the thread I’m hanging on.

Everyone says, “Sue the bitch (who sold you the dog)!”  Easier said than done.

Yesterday I had a telephone consultation with an attorney from the State Bar Association’s referral service.  He listened to the “short version,” told me he had no experience with cases like this but would be happy to litigate it, outlined the essential steps, reminded me that his hourly fee is $210 (a bargain, actually), that the case would cost a minimum of $20,000 to litigate, that we would surely win, that the first thing he needs to do is to examine the purchase contact and look at some other things, and that in order to do so he needs a $5,000 retainer.

Phantom Limb Pain.

Before I became a disabled person, back in the days when I went to work every evening, relished in healing the sick, lame, and halt, and also in bringing home the bacon and frying it in the pan: if someone needed a legal spanking I had only to pick up the phone, and if my own attorney couldn’t do it, he knew someone who could.  Retainer fees?  Not a problem.  Not a question.  Not required!  Don’t even offer!  They knew I was good for it, and besides, they might need my expert witness services one day…or their kid might need to be sewed up on a Sunday… But now all I have to offer is

Phantom Limb Pain

as I am cut off from myself, and I can’t get back what is gone

I can feel it, even see it, but it’s gone

And now I have to beg some abogado, please, please

If you think my case is so straight-forward, please take it on contingency, or reduced fees, or even pro bono

I have Phantom Limb Pain, don’t you see

I’m not what I once was
I find myself in reduced

circumstances

I am among the lame and halt now
As one day you yourself might be

As odd as that might seem

No one ever dreams it will be them
Believe me, Mr. Esquire, Sir, The Hon.,

no one ever

believes that it can get worse

But it can get worse

And then it can turn into

Phantom Limb Pain

Just What the Doctor Ordered (NOT!)

So I was doing my Friday-before-the-Sabbath errands, and I happened upon a hardware store that looked like it just might have the small desk lamp I wanted for my new tiny Jerusalem apartment.  Oddly, hardware stores here do not carry lighting fixtures.  You have to go to a lighting fixture store in one of the industrial districts for that, which entails buses and such, and I have not quite got over my jet lag enough to want to go adventuring.  But this store looked promising, so I turned from my trajectory to go in and check.

And that’s when it happened.  I’m not sure exactly what happened.  I think I might have caught my left toe, the one that drops because of some old neurologic injury, on the highish step one has to step onto to enter the store.  However it occurred, I woke up with people dragging me to my feet.  I saw someone throw the sandal that had ended up on the sidewalk into the store (thank you), and I was placed in a chair and given a glass of cold water.  I noticed blood dripping down my right arm, and upon inspection saw that somehow a piece of skin had been torn all the way from my wrist to my elbow, and was hanging in the breeze.  I tore it off, to the hardware store’s owners’ great dismay.

I asked to wash the wound, and was shown to a sink that looked like it was usually used for washing grease of implements.  I washed the blood off, and asked for a paper towel in which to wrap my wounded forearm.  I sat back down in the chair, feeling a bit dizzy, and listened to the proprietors speculating in Hebrew about how I had tripped on the step because I was wearing sun glasses and a big floppy hat (which everyone wears in the blazing sun here).

All I could think of was getting to a pharmacy for dressing materials before everything closed down for the Sabbath.  I collected my previous purchases, which had scattered all over the place, thanked the proprietors for their help, and fought my way through the surging multitudes of last-minute shoppers at the shuk to the Russian pharmacy that was, thankfully, still open.

I had to specify exactly what bandage materials I wanted, since after I showed the pharmacist my wound he looked rather ill.  Taking my stuff, I headed home to wash and dress my avulsion.  As I was walking home I noticed that my lower front teeth were sore.  I wondered if they were loose.  Then I noticed the bruise on my shin.  Classic KO punch (for those of you not familiar with boxing, a direct hit to the chin is a good way to knock someone out).

But: I went down before I got the KO punch.  What precipitated the fall?  The drop-foot?  Or perhaps….the thing that made me fall a few years ago, in the middle of the night coming back from the bathroom, that resulted in a concussion that caused all kinds of mayhem in my already compromised brain for years?

Anyway.  Three days later I’m still feeling headachy, nauseous, and grumpy.  The first day I fell asleep immediately upon returning home (after dressing my wound) and slept through till the next day, with one break to take Noga out to potty and to feed her.  She wouldn’t eat, but curled up next to me on the bed.  Yesterday I slept most of the day and went to bed at nine and woke up at ten today.  The wound is getting better every day.  I’m getting better every day.  I decided not to go to the doctor because last time I went to the doctor for a mild head injury it turned out to be a big balagan (pain in the ass, in Hebrew) and they didn’t do anything anyway.  So I figure if I turn out to have a subdural hematoma (blood clot on the brain) I’ll do it quietly and without a big fuss.  My friends are checking on me, so if I don’t answer the phone they’ll know something’s up and come looking for me.

Kind of cynical, but that’s how I am.  I guess I’m passively suicidal, always have been.  It’s like, I’m not afraid of death.  If something comes to get me, I’m on that bus.  If not, I’ll just keep on keepin’ on.