Blood, Foot and Tears

My visit with Dr. Ralph on Friday went fairly well, all things considered. My cholesterol was down to normal human levels, blood pressure was great and liver was doing just fine. I'm not sure why he brought up the liver, unless liver damage is one of Crestor's side effects. (Yeah, I just checked that and turns out Crestor's well known for its liver damaging capabilities. Mine seems to be unharmed, though, so good news there.)

I was pretty sure Dr. Ralph was likely going to hassle me about my weight, particularly since he's brought it up in all of our previous visits and has seen no evidence of any loss. In my defense, I have actually lost weight between our visits, thanks to the Slow Carb Diet and a brief dalliance with the Mediterranean Diet, where you're supposed to eat exactly like Mediterranean's eat, cause they apparently don't have any fat people over there. I lost weight with Slow Carb, albeit not as swiftly as its chief proponent Tim Ferriss indicates in his book Four Hour Body. My Mediterranean diet was not as successful, however, because I wound up eating pretty much anything I wanted on the grounds that I felt most Mediterraneans would really like Reese Cup Ice Cream if only they'd try a bite.

Unfortunately, our trip to Florida resulted in a binge week that sort of kept going after we got back, earning me a enough return pounds that I was only down a little bit from where I was at my last visit to Dr. Ralph. Secondly, Dr. Ralph's scale is a damned dirty liar, because it said I weighed a full 10 pounds heavier than my own scale at home did this very morning, post-dump. Thirdly, and most damning to my case, is the fact that one week ago I threw my back out buttoning my pants. Yep. Stepped into some pants, went to button them and threw out my back through the sheer power of my fatness.

Actually, the pants in question were not even a tight fit, there was no straining involved and thus it came as something of a shock when I subluxed a rib in the process of buttoning them. I then spent a day unable to turn my head properly or lift even lightweight objects without pain. I followed the wife's advice of stretching on an exercise ball, took some Alieve and felt a little better the next day. Felt so good, in fact, that I did even more stretching and then found myself nearly unable to get out of bed on day 3. I got half out, realized I couldn't go any further and that returning to a prone position was gonna hurt pretty bad too. So I just sat there on the edge of the bed, propped on my good arm until I finally could relax enough to sink back to the bed.

This sort of thing happened to me a couple of years ago--about this time of year, in fact--and lasted about a week before I could get the rib back into place. Despite my wife's manipulation techniques, it remained out of place through this morning.

Dr. Ralph tried a few manipulative techniques for getting the rib back into place, but wasn't quite successful.

Meanwhile, on the foot front... it turns out that the edema the radiologists saw in my MRI wasn't even located in the part of my foot that hurts, but was in the ankle, instead. The part of my foot that hurts still shows Jack Shit as far as any causative elements. Dr. Ralph explained that an MRI is capable of seeing arthritis, but wasn't showing anything that might cause pain in my foot. He wasn't sure if a podiatrist would be able to do much, either, since the one test they could order to show them what was wrong had already turned up nothing. Dr. Ralph said he was open to any suggestions.

I asked about acupuncture, as my massage therapist sister had suggested it. He said give it a whirl.

In the meantime, he recommended not using it so strenuously in exercise, such as when walking or running. Then we had a good laugh, cause the only time I run is when being chased. I explained that I probably would have been walking on it far more strenuously, since power walking is my exercise of choice. However, when I go walking it's with dogs and there's not much way to get good exercise with them stopping to sniff or poop every four feet. I assured him I wasn't putting huge strain on it. But, of course, he also suggested losing weight would certainly do my foot no harm and would put less strain on it.

Now I guess I'm off to the gym, sans dogs.

My EFFing Foot: The Saga Continues?

Well crap on a monkey, whack him in the head, bake him, mix him with cream cheese and curry powder, spread him on a cracker, then crap on the cracker, too.

Dr. Ralph called today with the results of the MRI of my foot.

Want to know what they found?

A steaming pile of NOTHIN', that's what!

As far as anyone can see, there are no stress fractures, no neuromas, no horrible foot cancers, no alien implants, no nothin'. They do say there MIGHT be a slight edema in the tissue, but nothing that seems like it would cause the sort of pain I'm having in my foot. I was quietly livid, as well as a bit sick to my stomach. A) I'm pissed that after nearly four months I still don't know why my foot hurts nor does it seem likely that I'm gonna find out any time soon; and B) I dropped nearly $800 as a copay on that EFFing MRI, and had to jump through five weeks of physical therapy hoops just to have the chance to do it! And I still don't know how much the physical therapy is going to cost! AAARRRRGHH!!

"Well, that's how it goes sometimes," my wife told me.

"It's how it... ? But... Five weeks of... Eight Hundred... Mother f..."

Grrrrrr.

I've now had the afternoon to calm down about it, but I'm still smoldering somewhat. I'd best be careful, though, otherwise when I go in for my checkup with Dr. Ralph in the morning, my blood pressure will be up and put me back on meds for it.

To be continued, I guess.

MRInterlude

After six weeks of physical therapy during which my foot stopped hurting not one little bit (though, in its defense, it hasn't gotten one little bit worse either), the previous theory that I was suffering from a neuroma has been moved into the "unlikely" column. Don't get me wrong, I had a blast talking to Jacko the physical therapist, but he was the first to suggest that a neuroma might not be the problem when my foot saw no improvement after 4 weeks. So last week Jacko and Dr. Ralph had another talk with my insurance company and asked them to reconsider their refusal on the proposed MRI of my foot to find out what the hell is really wrong with it. ("OY! He needs it!") Yesterday I learned that insurance has now said the equivalent of "Fine! Whatever!"

My MRI was scheduled for this morning. They hoped to have the results ready for my previously scheduled cholesterol appointment with Dr. Ralph tomorrow. In fact, I needed to be sure to go get blood work done for that, so they'd have my current cholesterol results, too.

"Are you scared?" the wife asked this morning.

"No," I said. And it wasn't the first time she'd asked me if I was nervous or scared. I wasn't even really sure why she had asked it, since to my way of thinking I was just going in to stick my foot in a big noisy machine for a while. It wasn't like radiation was even involved, or that I was going to have 19 feet of colonoscope shoved up my ass; it was just magnetic resonance waves. The worst thing I'd have to worry about was pissing off the techs if I accidentally moved my foot during the scan. But I also knew that she was asking as a person who had been inside an MRI machine as a patient, a few years ago. I know for a fact I was very nervous then and all I had to do was pace outside the door, listening as the enormous, farty-sounding MRI machine tried to change her polarity.

"Is there anything I should wear, or not wear?" I asked her, meaning should I leave all metal at home, or wear pants without a metal button? She said it didn't matter, since they would probably make me wear one of those assless hospital gowns. Great, I was more nervous about that prospect than the test itself.

I arrived at the hospital and checked in. On the way back to the MRI machine, the technician asked if I needed to use the bathroom in advance of the test. She said it might take a half hour. Despite my two cups of coffee, I didn't need to and just motored on. The technician and I sat down first in the MRI room where she asked a bunch of health questions to make sure I didn't have any metal within my person or other health conditions adverse to being magnetically resonated. Nope and nope. She also seemed prepared that I might be nervous, but didn't mention any assless gowns. In fact, she gave me a box to put all my pocket contents and belt into, but otherwise I was free to stay in my clothes. Sweet.

That done, they had me lie on the MRI machine's bench, clamped a foot-shaped box over my actual foot, gave me a bulb to squeeze should I decide to panic about anything, gave me some ear plugs for the noise, then raised the bench and slid it into the machine until I was in up to the knees.

I lay on the bench, my arms crossed on my chest, as there wasn't really room to keep them anywhere else, and thought deeply about keeping my foot as still as possible. Oh, but what if the noise of the machine startled me at first and I flinched? Would that ruin anything? I decided I wouldn't.

The machine was very noisy, but this one seemed much less so than the one that had scanned my wife's noggin. Didn't even feel like I needed the ear plugs so much, especially since it was only very noisy about three out of every ten minutes and just sort of hummy the rest of the time. On a couple of occasions, it made sounds that felt like a techno beat, even layering another beat on top of the first one. I started trying to make up melodies in my head to match it.

I tried closing my eyes for a while, but the room was nice and warm and the vibration of the machine was sort of soothing. I was a little concerned I might go into a light sleep and do one of those all body flinches I sometimes do when nodding off. So I kept my eyes open and stared at the ceiling and at the front of the MRI machine above me. While the housing of the machine itself was made of a cream-colored metal or plastic, the front of the machine had a translucent aqua plastic facing that looked like it would have a nice texture. I wanted to reach out and touch it, but that would surely jostle my foot. Just above the machine's digital display, in big metallic letters, was the name of its manufacturer: SIEMENS. "Huh huh, huh huhhuh," Beavis laughed in my mind on reading this, just like he does every time I see one of their ads on TV. (C'mon, SIEMENS, I know it's the name of your founder, Werner von Siemens, or some such, but really? Couldn't come up with a name for the company that didn't send every 12 to 40 year old, juvenile-minded male into silent giggles every time we see it written? All right, so you've been around for 160 years and have more than earned the right to call yourselves whatever the hell you want. At the very least you could stop sounding so proud of the name while repeating it 50 times in every one of your TV spots. Just sayin'.)

While lying on the table, I remembered I needed to go have my blood drawn for my cholesterol check. Since I was near Dr. Ralph's office, I figured I could just roll in there and let their phlebotomist have a vial.

At what I guessed was the midway point of my time in the MRI machine, I noticed that I really had to pee. Why hadn't I gone before? This made the rest of my time in the machine seem to take longer. Around what felt like the 28 minute mark, the technicians came on to ask if I was doing okay and to let me know I only had one more scanning session and we'd be done. Within a few minutes they came in and rolled me on out of the MRI, gave me my crap back and after putting on my shoes I was done.

Only as I was on the way to the car to head over for the blood draw did I remember that I'd eaten a massive bowl of Cheerios for breakfast, which would sully any blood results. With my appointment on the morrow, I would not have any time to get blood work done. So I called Dr. Ralph's office and rescheduled for Friday. Don't know if that means I'll have to wait until then to hear about my foot, but maybe that will give Dr. Ralph time to come up with a game plan for fixing it after he hears the results.

From what I was told, they're supposed to have the results for me by tomorrow, when I was scheduled.

When your old roma's looking ratty, pick up a neu one.

Had my first physical therapy session. No huge whoop.

Earlier in the week, the wife and I had lunch with Dr. Ralph at his office and he showed me my x-rays from last week. He said they were clean and didn't show any fractures, though this wouldn't rule out a stress fracture necessarily, as they often don't show up in x-rays. He said I'd be in good hands with his friend Jacko, one of the physical therapists in the area. His name isn't really Jacko, but that's a similar name to the one he goes by, which also isn't his real name. In fact, if you took the famous 80s Australian Energizer Battery pitchman Mark "Jacko" Jackson, aged him 30 years, grew his hair out into a gray pony tail, removed his Australian accent and penchant for shouting "OY!" in your face, and put him in scrubs, you'd have something that approached what our local Jacko looks like.

On Thursday, I went to see Jacko for the first time.

Jacko's was a tiny two room office in one of the local medical arts buildings, into which he'd manged to stuff four curtained off patient areas, his own desk area, a small library and his receptionist's desk. The quarters were cramped enough that I felt like I was co-starring in Das Boot.

On my way back to my particular curtained off patient area, I met Jacko himself. I'd not yet had my patient history taken, but Jacko grinned at me, shook my hand, took a quick gander at me and said, "So's it hurt your heal?"

"No," I said. Do I look like the kind of guy who has pain in his heal? Eh, maybe.

"Front of the foot?" he then asked.

"Yeah."

"Got a planter's wart?"

"Nope," I said.

He paused for the briefest of moments, as though weighing his odds at a fourth guesstimate diagnosis. "All right. I'll be in there in a minute." I'm still not sure what this was, but my impression is that he was trying for a Holmesian visual diagnosis and had missed his intelligence roll.

Several minutes later, after his assistant had taken my history, Jacko came back to have a look and a feel of my foot. (I'd washed that foot extra, for his benefit.)

He listened to my description of the situation and how I didn't really feel pain unless the foot was bumped or squeezed from the sides of the front of it. Then he clamped down on the front of my foot and gave it a solid squeeze.

"WAAYAAEI YEP, THAT'S IT!" I yelped.

He then examined the toes, pinching between each one and further down the foot itself until we located the tender point of the pain, about an inch back between This Little Piggy Had None and Wee Wee Wee.

I agreed that this area seemed to be where the pain was focussed, but that it actually spread out across the entire front of my foot when agitated. I reached down and tried to squeeze my foot so I could feel the sensations of the pain in order to describe it. Somehow, though, I couldn't really feel the pain as well when I squeezed it, likely because I can't bring myself to really give it a go

"Nope, you're going to have to do it, or I can't feel it," I said. Jacko was more than willing to squeeze the hell out of the sides of my foot again. Physical therapists are all about gain from pain.

"YAIYAAIE YEAH, THAT'S WHERE IT IS, ALL RIGHT! " I shouted. "Yeah, I can definitely feel that below my big toe."

Jacko seemed to think this was curious. "Have you dropped anything on your foot recently?"

"No," I said. It is very rare indeed that I drop anything significant on my foot. In fact, since age 5, I can probably count on one and a quarter hands the number of times I've dropped something on my foot. I don't know for sure, of course, but I've always thought this stemmed from the time when I was five-years-old and decided I wanted to be Charles Atlas. We were at my Mamaw's house, in back woods Wayne County, Mississippi. I'd seen one of the Charles Atlas ads in a comic book and asked my dad what I had to do to get muscles. He he told me I had to lift weights. He even found me a weight to try it with in the form of a 5 pound cast iron iron, of the sort people used to heat on the stove and then use to iron clothes, but which later became common ly used as doorstops around the time electric irons became affordable. I was only allowed to lift this weight while wearing my hard Sunday shoes, so I didn't drop it on my foot. Of course the one time I decided I didn't want to hassle with putting on my Sunday shoes, I dropped the thing on my foot, and but good. I had blue toes for a week. Since that time, though, when I cause something to fall toward my foot, be it from dropping it from my hand or accidentally knocking down a shampoo bottle in the shower, my feet automatically move out of the way of whatever is plummeting toward them, even to the point that they've done it while my eyes were shut tight from getting soap in them. My theory is that having something dropped heavy on my foot at so early an age caused me to develop hyper-vigilance of the feet and super-charged my pedal reflexes. My wife will tell you that bullshit, but it's bullshit that makes sense to me. (Hey, that would make a great title for my first book. "Some Bullshit That Makes Sense To Me.")

Jacko considered my foot some more and said he thought it was probably a neuroma, which is extra growth in nerve tissue, sometimes caused by a tumor, sometimes just agitation. Actually, Jacko told me what specific type of neuroma it was, but I wasn't listening so good at that point because he was still squeezing the shit out of my foot in his demonstration of how the tissue between two of the bones had become enflamed. He didn't rule out stress fractures and agreed that an MRI would likely show what was going on best, but neuroma was the likely candidate and he had some techniques which he thought would reduce the swelling. He was going to try electric shock therapy.

Okay, Jacko didn't call it that. He said he'd be electrically stimulating the tissue there. But I knew an electro shock machine as soon as he began adhering electrodes in strategic places along my foot.

"You're gonna feel this," he said, turning up the dial on a small black box. And presently I did, as my foot began to thrum with pulses of current.

"Yep, there it is," I said. Jacko set the black box down and said he'd be back in a few.

The shocks from the device were certainly not pleasant, but were quite tolerable. With each pulse my toes would curl on their own.

After about 25 minutes, the pulsing suddenly stopped. Was it on a timer? Was it out of battery? There was still a green light on the black box, but I was no longer feeling anything from it.

I called to Jacko's assistant, just beyond my curtain. "Hey, is this thing supposed to stop shocking me at some point? Cause it has."

Evidently it had run out of juice, while shocking Juice.

Jacko returned and had a look at the foot again.

"And you're sure you didn't drop anything on it?" he asked.

"I'm sure," I said. "Not dropping things on my feet is my mutant ability." I considered telling him about the cast iron iron, but decided the story would take too long and would risk having a licensed physical therapist scream "Bullshit!" in my face. Or, in this case, maybe "Oy!"

Jacko's question about my possibly dropping things stemmed from the fact that the symptoms seemed to manifest across my foot, rather than only in the tender point. This seemed odd to him, but not enough for him to declare it was something other than a neuroma.

My foot didn't feel noticeably different after the shock therapy, either, but this is just the first step. I go back next week.

My Right Foot

I've managed to avoid any sort of long term injuries in my life, beyond the occasional scar. The closest I've come was a scooter wreck in college which resulted in my sliding down asphalt on my bare hands for several feet. The way I landed in the fall did some nerve damage that largely curtailed my ability to put any weight on the side of my right knee or hold a tray in my job as a Pizza Hut waiter, for the better part of three months. All that stuff eventually healed, though. And I'm sure what ails me now will eventually heal as well, but even with that knowledge I'm mystified as to why my right foot has been giving me pain and grief for the past two months.

It started innocently enough. Just before my last doctor's appointment, I noticed that my right foot had a bit of an ache to it at the end of the day. It didn't hurt to walk on it at all. In fact, just putting weight on it and walking, even up and down my hilly neighborhood, gave me no indication of pain at all. Pressure on the bottom and top of my foot gave me no discomfort, but any pressure on the sides of my foot, near the toes, caused pain to go shooting through it. It was only a little at first, but it began to increase as the days went by. I couldn't remember hurting my foot, but decided it was likely to go away on its own. It didn't, though. I wondered if perhaps my choice of Skechers Shape Ups footware might have something to do with it. After all, I'd been known to wear them on my walks up and down the local hills and it seemed logical that the side to side rotation those shoes allow might not be great combined with hills. Why this would affect my foot and not my ankle I wasn't sure, but it was a theory. The other thing that popped into mind was that it might have something to do with my cholesterol medicine, Crestor. During my last doctor's visit, Dr. Ralph had asked if I'd experienced any muscle pain. I'd not realized this was sometimes a side effect of Crestor, but he said it could be. The pain in my foot didn't seem to be muscular, but what did I really know?

Of course, within a day of this possibility floating to mind, I caught one of those ambulance chasing attorney ads on cable for a guy trying to drum up clients for a class action suit against Crestor. According to the commercial, if I've experienced muscle deterioration, tissue necrosis, liver damage, seizures or sudden death, I could have grounds for a lawsuit. Now, I don't think I have any of those symptoms, and such ads are engines of instant fury in my house. However, hearing that such things are even remotely possible does cause one to look at one's foot and wonder. The wife's theory was that it could be a stress fracture.

"How do you fix that?" I asked.

"You stay off it," she said.

Days passed and the foot not only didn't get any better, but the pain got a bit worse. Still no problem with walking, but pressure put on the sides of the foot shot sharper pain through the whole foot. My wife had to be extra careful when examining it that she didn't press too hard or I'd scream like a girl. And lord help the dog that jumped into bed with us in the middle of the night only to land on the side of my foot.

Last week, I put in an appointment with Dr. Ralph so we could get to the bottom of this. The pain remained in the days before the appointment, too. It even worsened on Monday afternoon, after the wife and I did a bunch of yard work. The next morning, I expected it would be in full flare up for my appointment, but it wasn't. My foot felt almost completely fine, to the point that I could squeeze the sides of it with no pain at all. It felt at about 90 percent of normal. Was this all in my head somehow? Was the nearness of the appointment a trigger for a swift reduction in pyschosomatic pain? The wife suggested that, no, it was probably just an effect of the Alieve I'd taken before bed. But my foot felt better throughout the examination and subsequent travels around the hospital.

Dr. Ralph ordered x-rays, which we had taken, and an MRI scheduled for the weekend, which we would have to see if insurance would approve. It seemed insane to me, though, that we might have to go through the expense of an MRI, even one paid for by insurance, if my damn foot wasn't sure if it was injured or not. The pain did return by the afternoon, but it seemed pretty wussy to me to be complaining about a pain that didn't have any affect on me in the majority of situations. Then I'd step slightly wrong, or bump the side of my foot into something and the pain would flare up anew. Seemed like something that needed at least a diagnosis.

As of today, we learned that insurance has not approved my MRI. Their point is that MRIs are expensive and they'd only be willing to pay for one if I first did 4 to 6 weeks of physical therapy to see if that made the pain go away first. My point, and more importantly my physician wife's point, is that physical therapy is great stuff provided you know what the injury is that you're using it to treat. Insurance said they don't care. And I can sort of see their point. I mean, I'm able to walk with no pain at all for 95 percent of the time, so coughing up a couple of grand for fancy testing doesn't make as much sense for my case as it would for, say, someone who can't walk at all. And, really, I could live with my current level of pain for an extended period if I had to. I feel kind of wussy to be whining about it at all. One of my relatives has spent much of the past thirty years practically bedridden from back pain. I can walk a flight of stairs or even run, provided the surface was pretty level.

And because my pain is not so great, I doubt I'll be harmed by physical therapy at all, and could likely benefit from it. I'm game for trying it out either way. We've scheduled the first session for next week.