Is that right? Well, "fête" this, mon ami!

There's nothing like a little Placido Domingo to set the mood. OomPaPa, OomPaPa.

I've been somewhat lost these past few days. Part of the problem has been being overmedicated -- but that is now resolved.

I always wish for a stunning story to tell, something that'd knock your pretty little socks off. Unfortunately, my realities are about as dull as can be. OomPaPa, OomPaPa.

I increased my "base" dose of methadone -- and still was taking less than my pain management dude wants -- because I fractured my right hip.

How?

Well, my legs were hurting awfully, and the circumference of the right one was at an all time high, so I decided to elevate it on a few pillows.

That's it.
That's the whole story. OomPaPa, OomPaPa.
While lying in bed, with my right leg elevated, I fractured my right hip.

It's called a periprosthetic femoral fracture and I didn't know it was even a possibility -- to further fracture the femur *after* a hip replacement. As my bones and joints have steadily gone to shit, my bionic right hip was the star of the show -- it rarely hurt, it was rock steady, it was my one reliable major joint.

But the prosthesis must have been loose, right on the cusp of causing problems, for the humongous stress of elevating the leg to have cracked that bone.

The ortho explained that there were lots of predisposing and complicating factors in play -- osteolysis, osteoporosis, avascular necrosis, CRPS, and... osteomyelitis. Basically, the body kicks bone resorption into high gear in an attempt to get rid of the particles caused by wear-and-tear. My THR was back in September 2001. In fact, I went home via ambulance on September 11, 2001.

That was truly a strange morning. At the time, I lived in a major urban area served by one of the largest airports in the world -- yet the sky, framed by the boxy window at the rear of the ambulance, was a pristine, uninterrupted blue. You don't realize how accustomed you are to the sight and sound of airplanes until there is no air traffic.

Anyway, 9 years does not seem long enough time to wear out-- OomPaPa, OomPaPa -- titanium.

So I hurt quite a bit, and in response, raised my dose of methadone to within 10 milligrams of the prescribed amount! It's a strange drug, in that it could be considered a timed-release medication due to its very long half life -- 15 to 60 hours, in rare cases up to 190 hours.

In other words, it can sneak up on you. Oom... Pa... Pa... Oom... Pa... Pa...

I have a healthy fear of it, but even so fell prey to overmedication. After two days of returning to my pittance approach to pain management, my mind is clear and I have stopped drooling.

It was the wrong response, anyway. The best drug in my world for bone pain? Ibuprofen. [Actually, Toradol [ketorolac], but I can only get that in the hospital, and then for only three days at a time. As if my stomach lining could get any worse!]

So... much less methadone, much more ibuprofen, and the usual amount of break-through Percocet. Oom! Pa! Pa! OomPaPa!

If you follow this odd blog, you know that I'm without insurance, having been priced out of my coverage by BCBS of Tête de Hergé. They helpfully hiked my monthly premium to an unmanageable $1513, with another $5000 in deductibles. I am in the process of applying for coverage available thanks to the new health care laws -- as one of the few changes implemented *now* is access to coverage for people like myself: The Uninsurable. It is not great coverage; It is not perfect coverage; But it is coverage!

I feel like abusing semi-colons. (You may want to get out of the way.)

There are a few hoops through which I must jump, and there is the surprising issue of emotional upheaval causing mental and physical stasis. As in -- I am depressed, and stuck. I mean stuck in the technical sense of the word, of course.

I am afraid.

The infection in my bones began, it is theorized, thanks to one of the many orthopedic surgeries I've had to undergo because of rampant avascular necrosis, helped along by my suppressed immune status. Orthopedic hardware served as a petri dish. Despite the presence of evident abscesses, despite pus accumulating to such an extent that the head of my left humerus literally burst when the shoulder prosthesis was removed... the offending organism(s) will not grow in lab cultures. I had bilateral replacements, then several antibiotic-laced spacers on each side, then new TSRs -- even though we knew that infection remained -- despite course after course of intravenous antibiotics that should have killed any microbe within a square mile of moi. My infectious disease doctor almost begged me to fire him, saying -- and it was a real confidence-boosting moment: "I don't have a clue what to do next."

ew-w-w-w-oom pa pa, oom pa pa-a-a-ahhh...

The latest plan is to leave me without shoulders. No prosthesis, no spacers. No hardware, period.

I suspect, without any proof whatsoever, that whatever morphing of bugs has gone on is due to the nefarious influence of CRPS. It's the standard move when we don't know what's going on -- blame CRPS, because no one anywhere can figure that stupid disease out. Got a wart? CRPS! Is that a freaking stye in your eye? CRPS!

Given the reluctance of any sane orthopedic surgeon to operate on a limb with CRPS, my orthopod is a real hero. In total, he has performed seven major surgeries on my shoulders. Yes, my CRPS "spread" to take in both arms, fully -- but I am not convinced it was due to the surgeries. Pre-op regional blocks were done each time, and, true to form, I never kept either arm immobilized (as instructed!). For the longest time, I did not even care about upper body involvement. Now, as my hands become testy -- clumsy and burning -- now I pay attention.

En tout cas. So when OrthoMan came up with the plan to totally disable my upper body be eliminating these pesky shoulders? It wasn't a cop out. It was him saying what had to be said.

oomph pah-pah oooooomphh pahhh-pahhh.

Add to this picture a newly fractured hip, and for total complication, make it a periprosthetic fracture in a person with advanced CRPS, AVN, and an unresolved osteomyelitis, and you've the punchline to a bad joke!

When I sat down to write this morning, honoring my ongoing attempt to do so everyday, whether anything worthy is produced or not, I had the fête nationale française in mind as a topic.

Also percolating around up there in the grey matter were some words of wisdom about getting along with others, and a killer tricolore pasta salad recipe. Other people surely don't have to contend with so much crap when they try to write a sentence.

Fear won out, obviously.

How long can I continue with daily fever spikes, pain that gets worse instead of better, clothes and skin drenched in sticky salty sweat? I have been given an answer, you know. This is it: "Until you can't." And then, in response to my smartass query as to how I would recognize that state of "I cannot go on", came this equally smartass pronouncement: "You will know."

It's like my doctors have decided to become annoying incarnations of Yoda.

Fear is the path to the dark side. Fear leads to anger. Anger leads to hate. Hate leads to suffering.

Grave danger you are in. Impatient you are.

Do or do not... there is no try.

OomPaPa, OomPaPa.

Maybe it is not fear I am feeling. Maybe it is grief. Each episode, long or short, now leaves me in more pain, and more disabled. And my level of pain and disability now actively impacts how the doctors come to various decisions.

As in, it is okay to leave her without shoulders, with one fractured hip, and one collapsed hip, because she is already in a wheelchair and already has limited function of her limbs.

I'm sorry, but last year's celebration of the Jour de la Bastille will just have to be recycled. It's not as if the words to the Marseillaise have changed in the intervening 365 days; It's not as if freedom is on the march.