Lazy Daze

So I played my "tease" earlier this afternoon, by mentioning that Fred and I had taken Ruby the Honda CR-V on a jaunt to the orthopedic surgeon's office.

That's right, we zigged north, then zagged a bit back to the south on a different parallel, turned left (which I like to call "west") and followed the edge of the Airport Lagoon (very near the government offices for the theocratic divisions of the Lost Alp canton) until we reached ShoulderMan's hip-and-happening, totally digital office suites.  We have been there so often since the summer of 2008 that Fred is considering adding it to the underground tunnels issuing from the Haddock's ancestral home, Marlinspike Hall.  But since we are really just Lower Caste Caretakers of The Manor, he feels like he needs Captain Haddock's permission before digging.

You will note that I did take the time to copy-and-paste an entry earlier, as I felt like blogging but also wanted to pout and drink a fifth of whiskey.  It was a long appointment and we got lost on the way home.  My fault completely, because for some reason I said "straight ahead" when I meant "northeast."

I just spent a fair amount of time filtering the day through my sieve of a brain as I composed an email to a dear friend, Ms. Diana-With-An-H.  And since another dear friend or five will be dropping by the blog tonight, I figured I'd post my second cut-and-pasted email of the day.  You'll probably learn more details about ShoulderMan's digs and doings that way than if I just sat down and started some sort of fantastical preamble...

So "Howdy High" to my several Carols, the Brother-Units, Tully, and the incomparable Pig Man -- plus to all my favorite Spammer Blog Bots and especially to whomever it is back in Berkeley who still visits every 17.2 hours, as well as The Weirdo from Ames, my most faithful reader.

And how is this for a promise?  The next post, which may come tonight, actually, will be the long awaited Feline Video Update you've been CLAMORING for.  "Clamoring,"  I say, "CLAMORING!"  Yes, we are in need of some not-so-serious amusement around here.

Here is the missive just delivered to one of the Interwebs Best Buddies, Diana-With-An-H.  Oh, so that I may be even *more* lazy, here's what you need to know about her, beyond her general wonderfulness: she was cooking up something awesome for her husband (a very lucky man, in ways I cannot begin to explain) and she has been helping nurse a friend who just had a mastectomy.  "Lazy Son" is, specifically, Nanette's son... and the three of them went out to lunch yesterday.

Krapola!  I probably should peck out a bunch of footnotes to further erode your reading pleasure!

But I won't!

hey.

good for you -- now come cook us something!  nah -- yesterday i whipped up some soup for fred and the lesbians (+ miss kitty, grrrr) for the famous wednesday night "church" supper.  i was so out of it, it took me about 4 hours, which was ridiculous.  but it was good!  cream of potato with charred red pepper, black beans, and caramelized veggies.  he brought home the leftovers and it fed us today, which was nice.

we are doing a lot better today, for some reason.  or ... NEWS FLASH:  when i don't say a word about how i am feeling, he perks up and chatters away, the sweet boy.

i bet brenda did feel awful today... she sounded a little too energetic the other day.  and the radiation can be very debilitating but she knows that. she sounds like one tough cookie.  i hope she gets some rest... bless her heart. (and yours)

hey, is lazy son any sharper when annette is around?  and how are you and annette doing these days?

okay... so.  the visit was not good.  there were, however, two hysterical moments.  

1.  remember, i practically LIVED in the man's office from august 2008 thru the fall of 2010, and even popped in after losing my insurance.  he has an intellectually-challenged guy who works as his nursing aide, named Rex.  Rex is sweet as heck and knows me very well.  when he called my name to go back to the exam room, i was filling out paperwork and promptly dropped the clipboard, sending the forms flying, then knocked over a sign on the table when i reached to retrieve them.  well, while i was picking all that up... a woman got up, said "here i am," and went back to the back with him!  so that left me in front of the closed lock door yelling "rex!  rex!  i am locked out!"  finally a receptionist went and opened the door for me.  and there was rex, giving me the evil eye.  i didn't know rex had an evil eye in him!  i said "hi" and flashed him a toothy grin.  he said, suspiciously, "who are you? and who is the woman i just put in your room?"  turns out this long, lithe, lovely lady was pissed at having had to wait, and that, according to her, she should gone before me, having arrived earlier.  i mean, who gives a shit about stuff like "appointment time"?!  rex thought he had lost his mind, or that there were two profderiens (an *absurd* proposition) or that i had experienced a miracle, been cured, and was out of the wheelchair, looking like a fox.  they didn't even make her go back to the waiting room, but he did at least get my chart out of the box on her exam room!  rex is really wonderful, usually -- the time i kept landing in icu hitched up to a respirator?  when i went for the first postop appt, rex gave me a bear hug (can you say OUCH?) and burst into tears. "i was so worried about you!" 

2.  where was fred during all of that?  well, last night, at the "church" supper, he was washing a dish, put his hand in the dish drainer and got stabbed in the finger by a knife that someone had left point-up.  in the doctor's waiting rm, it opened up and started bleeding again.  so he got up to ask for a bandaid... and the woman handed him a "medical history" form, saying "you'll have to fill this out, first."  
the whole room cracked up...

okay, now for the serious stuff.  there is a 2 mm "black-ish" space surrounding the shaft portion of the implant, extending around its end for at least 3-4 inches.  that's the major change... and it usually means you-know-what.  it is very likely an infection as the only other option is air and he didn't 
agree with me that maybe i hiccuped and the air went down the shaft of my prosthesis into 
the humerus itself.  

he's a spoil sport.

the other changes were not "new,"  they were just "worse."  my rotator cuff is *still* missing!  it ran away and just left me with a bunch of painful calcium deposits, and they aren't even in the bone (since there isn't anything but titanium in that area now) but are sitting in the soft tissue.  ouch.  okay, so i thought it might reappear after it first ran away back in february 
-- i have always been fond of my rotator cuff tendons.

come home to moi, my tendons!

shoulder humor.  sad.  

anyway, there's been a widening of the space between the "ball" and the "shaft" parts of the shoulder prosthesis as a result.  it was also just very... i dunno... irregular looking.

he did not even push the range of motion of the arm -- first, he sees what you can do, unassisted (which was almost nothing), then he asks you to relax it while he moves it.  he almost never STOPS when you say/yell "stop," but today he barely even tried to move it.  second, he asks you to put your palms together and then he tries to hold them together while you attempt to move them apart. we did some weird imaginary form of that part of the exam. then everyone stood around and made noises-of-sadness-and-pity over the progression of the CRPS in my arms and legs.  {rolling eyes toward heaven}  shoulderman won many points by asking "why did you shake my hand?" now *that*, my friend, is CRPS/RSD*awareness*.

there *may* be more fractures up above as well as perhaps in the shaft.  i don't really care about that but he does, because of the fact that the next prosthesis -- IF there will be a new one -- has to be a REVERSE prosthesis.  to understand how different that is, here is a normal prosthesis: 

and this... is a "reverse" prosthesis. The Tribunal of the Holy Office of the Spanish Inquisition is credited with its design:

anyway, for today, he gave me a shot of [what else?!] steroids and some local anesthetics.  he asked me to have go-to-guy try to get some sort of results from the CT scan they did while i was in the hospital last week.  in other words, like me, he doesn't believe that they "didn't scan the left shoulder."  i hate to be the queen of conspiracy theorists but hell, i was *there* and i *know* they scanned it.  the a-holes just didn't want to be suspected "liable" for even more damage to this rock star of a body than they already have been.  grumble, grumble, curse, curse.  they should know that if i haven't sued them by now, they are not gonna get sued... i've never sued anyone in my life. 

i should have taken every available penny from the bastards back in 2002. 

the plan is that i am going back in about 6 weeks -- if i can wait that long.  i get to go in early if i reach what we are calling "desperation."  i wanted to respond to that escape clause with something really snarky, but then realized i'd probably burst into wimp gimp tears.  he wants me to hang in there until after i finish the antibiotics i started last week, then get back on the other antibiotic that go-to-guy is experimenting with... after he chats with go-to-guy and orders maybe another aspiration of the joint (i am against that... we have done EIGHT aspirations and NOTHING grows in the damn lab... why do we keep doing them?), after more imaging studies... and then he will likely remove the current prosthesis and insert one of those spacers laced with antibiotics.  

why? because he can't put in any sort of prosthesis if there is infection.  the spacers can stay in for months, tho the last two he implanted on that side had to be taken out because they were causing fractures and blahblahblah. in other words, i may end up with a series of spacers.  i also have a pretty good chance of ending up without a shoulder at all.  but we won't go there now.

this is what a spacer looks like (modigliani design):

 he gave me one like that once, but he also made one on the spot in the operating room by shaping it himself out of surgical cement.  that, i would have liked to witness!

well... this is way too long, sorry.  my brain is on overdrive, my temp is 101, and i feel like my legs are aflame!  woo hoo!  it's party central in the manor tonight.

i hope you are in your jammies, warm, cozy, and chilling out.  tell brenda i send her good wishes and hope she kicks cancer's big fat ugly butt.

oh -- when we got home?  we found rampant destruction... since dobby and marmy fluffy butt both came for the butt whacks they love so much, it was easy enough to infer that the guilty party was one buddy the kitten, whom we found hiding in the dirty clothes hamper.  more on that in tomorrow's tome!

smooches galore and fruited loops,

moi 

What a mess...

It's a crazy time.  Given the extent of the wackiness around here, and the opportunity for more, I'll not be blogging for a few days.

Today I see the orthopedic surgeon, my old friend.  (I slept last night with my mp3 player set to repeat and repeat a Michelle Shocked album... "my old friend" is running around my brain to the tune of Anchorage... anchored down in Anchorage....

I took the time to write to my old friend

I walked across the burning bridge

I mailed my letter off to Dallas, but

Her reply came from Anchorage, Alaska

She said Hey girl it's about time you wrote

It's been over two years now my old friend

Take me back to the days of the foreign telegrams

And the all night rock 'n rollin' hey Chel

We was wild then

Yeah, well. So I'll be humming and buzzing along with the x-rays today.

Then we are rushing about Tête de Hergé like freaking maniacs, getting groceries (I am on a goodly dose of antibiotic and we are out of plain, lowfat yogurt.  Also vanilla extract, bread, and milk.  Not to mention caffeine-laced diet colas...) and a few other items of a more esoteric nature.

Then we are flying home to finish disassembling our wing of The Manor, Marlinspike Hall.

Why?  Are we being thrown out onto the streets?  If so, wouldn't The Brotherhood down the road take us in?  Yeah, couldn't we just crash at The Monastery?

No, we're not imminently homeless, we are just having some 16th century reclaimed beams and timbers -- heart of pine planks, specifically -- put in as "new" flooring here in our tiny section of the world. 

And don't knock The Cistercians, even in jest, because they're doing the installation...

What I really wanna know is:  Who bought all these damn books?

I have so much to do and such little space and time to do it in.  Also, I tend to injure myself.  Immediately.  Within five minutes of packing and piling and sorting and moving...  Yesterday, I spent the afternoon with tears rolling down my red, red face,  while putting my arcane collection of Objectivist Poetry into flimsy bags and boxes. 

When I was done, I heard this from My Darling Cohort:  Sweetie Pie?  Are you okay?  Do you need any help?

Wrong!  Well, only partially wrong.  Wrong in the sense that I implied that My Darling Cohort was not assisting.  Because he did.  A lot.  As in, a whole lot. 

Okay, I lied.  His offer to help preceded my headstrong and tearful attempts at packing up my tiny office. 

He's a good boy, is Fred!

The Felines are freaked and part of today's plan entails finding three carriers that we can safely stash them in, as the monks, who love them to pieces, tend to try and sneak them over the orchard wall, tucked in their voluminous robes.  When we retrieve them they reek of incense and garlic.

I have beaucoup medical stuff on tap for Monday and Wednesday of next week, too.  ["Too"?]  The thoughts and worries about the subanesthetic ketamine treatment never really leave my mind.  I am pinning a shitload of hope on this procedure.

So. Be good out there.  Stay warm, stay well, be happy.

The next time I talk at you, I will be able to zip around the place without the wheelchair meeting so much impedence in the form of medieval tapestries and persian rugs.  I'm gonna redefine the speed of light.

***  *************************************************************************  ***

Okay, so... here I am blogging again, less than a day after swearing off the activity.  I've said it before, and look!  I am saying it again -- I need one of those pensieve thingies, like Albus Dumbledore had stashed in his office.  The basin with swirling, shimmering vapors.  Thoughts as strings to be pulled out of the head, twirled on the end of one's wand.  Though I suppose a chopstick will do, in a pinch.

The Pensieve has multiple functions.


At times, when one's head is so full of thoughts that one cannot hear oneself think, it is useful to be able to take some of those thoughts and literally set them aside. The practiced Wizard can extract a thought from his head and store it in a phial or in the Pensieve for another time. If it is in the Pensieve, it is possible to stir the thoughts stored there together and look for patterns. It appears that the wizard has the choice of extracting an entire memory, leaving no trace of it in his head, as Professor Snape does in Harry Potter and the Order of the Phoenix, or extracting a copy of a memory, retaining the original, as Professor Slughorn does in Harry Potter and the Half-Blood Prince. It is also apparently possible to edit these extracted memories, though it is a difficult task and one which is often not done well.


If one places one's head within the Pensieve, one becomes immersed in a memory that is stored in the Pensieve, and is able to relive it as if one was living that time over again. Harry experienced Professor Dumbledore's memories of the Wizengamot trials of several Death Eaters this way in Harry Potter and the Goblet of Fire, and Professor Snape's memories of Harry's father in Harry Potter and the Order of the Phoenix.


A thought or memory stored in the Pensieve can, with proper stimulus, appear to nearby viewers as if standing on the surface of the basin. Professor Dumbledore used this technique to show Harry the prophecy that had been made about him, in Harry Potter and the Order of the Phoenix, and it is used in Harry Potter and the Half-Blood Prince when full immersion in memory was not needed.


It is also possible to take another person's memories, place them in the Pensieve, and then enter them to relive them as if one were the person whose memories you have just added to the Pensieve. Harry and Professor Dumbledore do this a number of times in Harry Potter and the Half-Blood Prince in order to determine the salient points of the early history of Tom Riddle, or as he later styled himself, Lord Voldemort.

This blog is my pensieve.

So... although we spoke of it briefly the last time I saw him, it sort of blew my mind -- and all its twirling little vapors -- when the surgeon offered up an inverted total shoulder arthroplasty as my sole option for my left shoulder.  He is fabulously talented, so to hear him call something "difficult" was scary.  It looks like this... and this looks WEIRD!

I guess I sorta didn't believe him in October when he first pitched this.  Or I developed amnesia.  The Good Doc says I've not much left to work with -- remember (someone has to), I have rampant avascular necrosis going on as well as osteomyelitis.  Oh, and I am now missing one rotator cuff.

No problem!

He's been such a savior to me, this guy, that I simply don't believe there is a technique or an obstacle that he cannot conquer or overcome.  I mean, he's done... let's see... 8 of my 9 shoulder surgeries. 

We were doing a pre-exam chat -- I was bemoaning the mess at the manor, the monks and the flooring... then the ketamine infusion therapy popped in my head, and consequently, out of my mouth.  But instead of giving him some background, or even notifying him that we were leaving the discursive region of home improvement and religious adherents for the vague regions of dissociative drug therapy, I just blurted:

"Guess what!  I'm gonna do ketamine!"

And his eyes bugged out.
And he opened, then closed his mouth.  Several times.
I could see the confusion and what may have been a burgeoning certainty of my extreme moral turpitude spread across his usually composed visage...

So I explained.

Which made it worse.

He thinks I am nuts for doing this.  Well, ptooey on you, Fabulous Orthopedic Surgeon!  Ptooey, I say, on you!  Then he went on and on about this upside-down, spikey prosthesis -- only an option, of course, if the joint space and long bones are free of infection.

Why am I always so confused?  (No, I am serious.  Why?)  Is there a cumulative but late arriving deficit that hits a person after so many surgeries, after so many foreign bodies are implanted, after nine years of insufficient sleep?  After all the pain, fevers, sweats?  How is it that I can block out such important information?  Denial?  I don't think I am in denial about anything, but then who does?  Do you know that last week, I managed to forget entirely that I have an "aortic root dilation" of growing dimensions -- now sitting right at 5 cm..  I got there because of a run of something or other, that ended in about an hour of trigeminy, and this thought:  "It would be so nice to have a heart rate under 112..." We are so wrapped up in stopping this infection that we haven't even scheduled an echo.  The last one was in ICU back in... July 2009.  Whoa.

Just what I need to indulge in:  more catastrophic thinking!  (Thar she blows!)

See?  I DO need a pensieve -- just to get rid of boring, scary, fruitless thoughts about stuff I cannot do crap about. 

Okay... I feel better.  The reverse shoulder option will only come to be when/if we rid my body of sneaky pathogens and the pain reaches the I-CAN'T-STAND-IT-ANYMORE stage.  With careful coaxing, I can stand a whole hell of a lot!

The title of this post stands unchallenged:  What a mess...

suicide by doctors

okay, so in the few hours since i published this scintillating example of self-pity, guilt at having bad-mouthed the good people who are trying hard to help me, and who are as talented as they come, has gnawed a hole in my inflated psyche.  and i thought the pain of rotting bones and insane nerve fibers was hard to deal with -- well, that pain is nothing compared with guilt.

so... i'm sorry, okay?  it's just that every now and then i decompensate.

[which would be a reason but not an excuse.  jeez, but you people are rough on a girl.]

*****     *****     *****     *****     *****     *****     *****     *****     *****

i'm taking another mini-break from blogging, although experience tells me that merely making that announcement is a surefire way to recapture my own flagging interest.

the visit to the surgeon yesterday was good, in that i like him and he tends to get the various balls rolling. the visit was bad, in that so much remains... hors la portée. 

we cannot rule out infection of the left prosthesis but we now have another very evident reason for some of the pain and dysfunction, at least.  there is supposed to be a subacromial space in the shoulder, a gap in the joint, that is generally of around 9 or 10 cm. 

below 6 cm of space, it's considered a problem.

i am in the negative -- i have no space.  i have negative space.  were the prosthesis not there -- and there with such élan! for it is there, and jauntily! -- were that hunk o'metal absent, it'd be just another one of my collapsed joints.  i am too familiar with the concept of collapsed joints and rotting bones -- with all their translations into krapola and ouch -- thanks to years of avascular necrosis.  there is also the odd klunk of bones trying to settle into some acceptable version of order and boniness (that'd be the weird audio component of AVN:  the sound of joints settling.  disconcerting, this sound.)

the quote i love so much is burrowing through my very depressed mind.  next, then, the traditional moment with spinoza:

each thing, in so far as it is in itself, endeavors to persist in its own being.

i would rather hear and know this than all the promises of heaven and salvation.  sometimes, don't you just want the truth?  unvarnished, prickly?  capable of collapse, were it bones?

oh, hell, the important distinctions, the big ass caveat:  the endeavor is NOT what has been called the [evolutionary] struggle for existence, no way, jose!  it is simpler -- and harder -- than that:

it is the result of a thing being what it is

[from translator r.h.m. elwes' 1883 "introduction," to the ethics].

a translator who likes to nail things down, elwes also adds:

When it is spoken of in reference to the human mind only, it is equivalent to the will; in reference to the whole man, it may be called appetite.

there.  now spinoza and his scrappy translator grace the page.  i can relax. 

or i can persevere and persist in my (own) being.  how about it? wanna join me?

okay, so we have the squirrelly case of the disappearing rotator cuff muscles, which, being trapped between pitiful bones were nonetheless dispatched, disappeared, and definitively poofed away, away!

he gave me a cortisone injection, which helped for about an hour, thanks not to the steroids but to the hefty dose of anesthetic involved.  knowing how i feel about such injections, he gave rapid lip service to the benefit/risk ratio.  bless the man.  he may be the only one on the ball... and since he's the one with all the scalpels, that's a good thing.

no word had been passed to him by either my go-to-guy or the new infectious disease dood.  the three of them all chatted today, however, and i have been sending emails back and forth to go-to-guy.  new ID dood opines, as did the consult we got last august, that if there is a bacterial bad boy, he votes for propionibacterium acnes, based on the deep reasoning that -- now, follow along: 

since nothing has grown,

the culprit must be

difficult to grow,

and the most difficult bacterium to hatch,

 in terms of joint contaminants,

is p. acnes,

so it must be p. acnes

that is not growing.

sigh.

i feel like i am surrounded by idiots.

that is a dangerous thing to say, the kind of thing that can get a person condemned to hell, or that can at least give you a terrible reputation and keep you out of the country club.

so go-to-guy has come up with what feels novel to him [because he has completely forgotten about the lame ass consult of last summer, the one where fred and i traversed the wilds of tête de hergé (très décédé, d'ailleurs) aboard a convivial ruby, the honda crv, only to spend a total of 7 minutes with the illustrious doctor man.  illustrious doctor man hemmed and hawed (but not much -- i mean, it took all of 7 minutes... that's including the disrobing, the exam, the review of records, the documentation -- in fact, he had it all written up already, he had already concluded, the book was déjà closed.  "i took the liberty of speaking with your surgeon, who is known to me...."  sigh. dickwad.  and that was the genesis of the propionibacterium acnes element of our folklore.] --

whoa, nellie!  if i were you, gentle reader?  i would bale out of that paragraph!  [whether you are to BAIL or BALE out is but another conundrum] what a mess! 

anyway, back to go-to-guy, who is doing an admirable job of ignoring every reference i make to impending suicide.  he wants to do a course of doxycycline.  a course, that is, of ORAL doxycycline.  i think the poor boy is confusing a bad case of zits (a shout out to my former friends at PTZ!) with the lingering, well-hid pestilence known as osteomyelitis.  but whatever floats his boat and more power to him for deigning to do anything!  something, anything!  i came * this close to quizzing him about the types of barriers that would have to be traversed, etcetera but, thankfully, i managed to be a teeny bit decorous.

my crp is so high no one will tell me what it is.  that bugs the good bejesus out of me.  i can pass along all the other lab values... but the crp is gonna... what?  make me faint?

i am being referred to one of shoulder man's colleagues, the hipster, because my right hip is refractured.

the easiest solution of all, in terms of diagnostic testing, would be one fucker of an mri.  and that won't happen because of the incredible number of implants, screws, and such that cause the images to torque to high heaven.

shoulder man introduced the idea of a reverse shoulder replacement, a funky little design that is exactly what it sounds like:

it would be a last resort, this slicing off of the humeral head!  but his little blue shoulder man eyes, they were

a-gleamin'!  with the disappearing rotator cuff, the collapse of the joint, this is what remains as a surgical option.

of course, we must be reasonable.   especially since the foremost contraindication is the same as the foremost complication.   

why, yes!  that would be infection.  {as god falls into the groaning maw of his own smart-assedness.}

so this all has me beyond blue.  they want me to renew my relationship with the medical school rheumatology department, try the antibiotic (orally, orally!), and open my mind to a reverse replacement.

maybe i won't take a hiatus from blogging. 

i fear the implosion of everything, and sometimes it is only the writing that successfully squares off with the sucking abyss...

and tames my natural tendency toward dramatic excess -- rare though it may be.

jeez, louise, but i am tired.