Is That the End of the Tunnel?

Well, I have been to see the podiatrist, and there is...news.

According to both the MRI and the x-rays that Dr. Giaradina took toady, there is a nasty infection in the bone of my great toe. On the x-rays it was so clear that even layfolk could easily make it out.

Dr. Giardina described it as millions of little tiny Pac-Men eating away at the bone and cartilage. One joint is totally destroyed, not even any cartilage left, and the Pac-Men are busily gnawing away.

So what does this mean? In a word, surgery. Apparently, infections in bone are pretty well protected from antibiotics and such, so the only way to get rid of them is to cut out the affected sections of bone.

Dr. Giardina is set to move on this; he said to expect surgery sometime next week. I will go in and they will knock me out (with drugs, I hasten to add), and then he will play Hawkeye Pierce on my poor toe. He said he will try to save what he can, but in the worst-case scenario I could lose my great toe entirely.

It's his opinion that the infection has been in the bone all along. In fact, he says that my original pain was not gout at all, it was the infection going to town. We still don't know what happened -- I don't recall any trauma, like stubbing my toe or dropping anything on it -- but he said that sometimes this kind of thing is a complete mystery.

So, where does that leave things? I will continue on IV antibiotics, which at least keep the infection from spreading into soft tissue. Some time next week, I will go in for surgery, and emerge with part or all of my great toe gone. At that point, everything will be sewed up (no more open wounds), and everyone tells me that recovery should be swift (2-3 weeks, but no guarantees).

I feel...relieved. Everyone I've talked to so far has said the same thing: "Looks like the end of the tunnel is in sight." Even though there will be adjustments, and I'll likely have to learn to walk differently, and maybe have ugly orthopedic shoes -- despite that, it will be over. One hopes.

Thomas reminds me a jaunty little song from The Simpsons, with which I will close:

Some folk'll never lose a toe,
But then again, some folk'll,
Like Cletus, the slack-jawed yokel!

-Don

Setback

Today I had an MRI, and I just finished talking to the Infectious Diseases doctor about the results.

It looks as if there might be a bone abcess, which is a bad thing. On Monday I'm going to see a podiatrist, who will examine the foot and confirm the diagnosis. If there really is a bone abcess, then the podiatrist might have do surgically remove a piece of bone.

As a more immediate consequence, they're extending my IV antibiotics for two more weeks.

As you can imagine, this is something of a disappointment. I am trying to be adult about it.

More later.

-Don

Fancy Footwork

Today at whirlpool, I had some fancy footwork done. No, not cool dance steps -- this foot work involved scissors, forceps, maybe even a scalpel, and lots of blood.

I'm not sure exactly what the nurse, Carol, was doing. She told me not to watch, and I followed her advice. (Thomas watched for a while, but then he said he was feeling a little queasy, so he looked away too.) Carol has such a gentle touch that I didn't feel much pain. When she was done, she put on a special dressing containing silver, which we aren't to change until we go back on Wednesday.

I'm choosing to take all of this as a positive sign.

While the actual process didn't hurt much, my foot has been hurting a bit more than usual ever since. I imagine it will settle down after a while -- but today I've been doing a lot of resting.

-Don

To the Apple Store

Today has been a busy day. We had a 10:15 appointment with Dr. Shavers, who wrote some prescriptions for insulin needles, blood test strips, and the like. From there we proceeded to whirlpool therapy, which is always fun.

After that, we went to Columbia Mall, where Thomas put me in my mother's old wheelchair, and we set off for the Apple Store.

You see, I've been saving up my pennies, toward the goal of getting myself an early birthday present (my birthday's in June). When all this hospital and home care stuff started, I decided that I deserved to get my early birthday present a little earlier.

So here it is, the newest member of our computer stable: a MacBook laptop that we've named "BrainiMac5" (don't ask).



This was a fun outing, but let me tell you, I was glad to get home! I crawled into my sickbed, took a percocet, and rested my eyes for a while before I even opened the new computer.

At least now I have someting to keep me busy over the weekend. :)

-Don

Better Every Day

Just back from whirlpool therapy. We got an early start today so we could pick up donuts for the folks at whirlpool. They've been so pleasant and so good to us, we figured they deserved a reward. And we certainly brought smiles to a lot of people's faces.

One of my four foot wounds is right on the verge of closing up, two more are well on their way, and the last one is making good progress. (This last one, at the base of my big toe, is the one with an exposed tendon -- very icky, if you ask me. Keeping the tendon moist and alive while the wound heals is appparently a concern. I just relax and leave everything in the competent hands of the whirlpool folks and Thomas.)

I'm still getting lots of wonderful cards, letters, and emails. I'm kinda amazed (and very touched) to see how many people think I'm worth the effort to pick out a card, write an encouraging message, and go to all the trouble of looking up my address and all that. I can't possibly thank everyone in person, but please know that I appreciate allthe good wishes. I figure each thing that makes me smile, brings me another step to full recovery -- and I've been getting a lot of things to make me smile!

People keep asking if I'm getting any writing done, and I'm hapy to report that the answer is yes. I have my trusty laptop right by my sickbed, and I've been able to put in a couple of hours every day. I'm taking this opportunity to work on something that's been on the back burner for years: revising a novel that I wrote a while ago. I don't want to bore everyone, so just let me say that A Rose From Old Terra is a science fiction story set in the year 6484, involving a group of Librarians who set off to save the Galaxy. Yes, it's (drumroll) Librarians...in...Space!

Revising an existing work is a lot less demanding than producing something new from scratch, and it's something I can do even under the influence of percocet. I've been enjoying the work, and am happy with the product. With any luck, A Rose From Old Terra will be out later this year from Speed-of-C Productions.

I am also working on an original short story, of which more news later.

-Don

Today's Outing

I am getting better every day. Without going into too much graphic detail, two of the wounds on my foot are pretty much closed up, and the other two look better each day. The folks at whirlpool therapy (three times a week) continue to be happy with what they see each session.

Today Thomas and I went to the Greater Columbia Fantasy Costumers Guild meeting, which was at the Savage Branch of Howard County Public Library. It was about a twenty-minute ride, and we stayed at the meeting for about two hours. This was my first major outing besides whirlpool.

The weather is dreadful, dreary rain and somewhat raw outside, but I was very glad we went.

It was great to see friends again, and nice to be out. And everyone was so very nice and supportive. Plus, it was nice to have some conversations that weren't about me and my body.

Still, by the time the meeting was over, I was pretty tired and my foot was feeling sore...so I was just as glad to head home. Guild meetings usually end with most people going to a restaurant, and I was kinda hoping to go along, but that's for another time.

Meanwhile, it was very nice to be out, and nice to participate in a...well, I hesitate to use the word "normal,", so let's say customary event. (Or dare I say "costumary"?)

-Don

Latest Update

One of the worst things about convalescing at home is that it's hard to find topics of conversation that don't involve my body. At least I'm not as bad as my Grandma Buck: for her last decade at least, her topic number one was the state of her bowels. She would start each day issuing a full report, and then gave frequent updates as events warranted.

Things are going well. They are pretty confident that the infection in my foot is on the run, although they're still saying that the antibiotic IVs will continue through the end of April.

I can hobble about with a cane, but still have to keep the foot up or else it hurts like the dickens.

(WARNING: Icky stuff ahead.) The four incisions they made in my foot are starting to heal; one is almost closed up, two are well on their way. The fourth one is this alarming-looking crater at the base of my big toe, where a ligament is still showing and the wound is still pretty deep.

On the diabetes front, they're still working on adjusting my insulin dosages. My blood sugar has been all over the place, but at the moment they're concerned that it's been very low in the mornings. Partly this is a good sign, because it means the infection is fading (the infection tended to cause high blood sugar.) But they also think I'm taking too much insulin.

This whole insulin fine-tuning is a process that will last quite a while as circumstances change. Once I'm back at work, they anticipate that they'll have to adjust dosages again -- being physically active is a lot different than lying on my back most of the day.

Had an appointment yesterday with the infectious diseases doctor. She booked me for a follow-up on May 1.

She seems confident that the IV treatments will end on 4/30. If she thinks I still need antibiotics after that, she will give me pills.

The big unknown is these wounds in my foot. We don't know how long it will take for them to heal up completely. The physical therapy people are saying probably end-of-April/early-May; the infectious diseases doctor said I may still be healing when we have our nex appointment on May 1.

I want to be sure to thank everyone for all the cards, letters, and good wishes.

Yesterday I was able to get some writing done, which is a really good sign.

And I received word that I've sold a short story to an anthology that's scheduled to be published later this year. That's good news.

-Don

Learning to Live with Diabetes

Still home. It's been an uneventful weekend, except for the routine IVs, meds, and dressing changes.

Today is Easter Sunday, which is the anniversary of the day Thomas and I met, at Balticon back in 1982. (Yes, one of our anniversaries is a moveable feast.)

Along with recovering from my foot problems, I am also learning to live with newly-diagnosed diabetes. I have a glucometer -- a little gadget for checking my blood sugar. First thing in the morning, and several times during the day, I poke one of my fingertips to draw blood, then touch the blood to the meter to get a reading.

I also have insulin. Not just insulin, but two kinds of insulin. Lantis is a slow-acting insulin that is supposed to smooth out blood-sugar variations throughout the day; Novalog is the more traditional fast-acting insulin that I'm supposed to take with meals. Both of these are injected, so Thomas and I are getting a lot of practice using syringes.

My blood sugar has been all over the map. Supposedly, a good range is between 70 and 120. If it gets too low, then there's danger that I will pass out -- as I did at whirlpool on Monday, and almost did on Friday. (The treatment for low blood sugar is to get some sugar into my system as quickly as possible, which means juice or cookies or even a packet of sugar. It seems odd to think of a diabetic deliberately swallowing sugar, but there it is.)

If the blood sugar is too high, it's also bad. Not as immediately bad as passing out or going into a coma, but certainly not good. Taking insulin helps to lower high blood sugar. The problem is, we don't have any magic formulas for how much insulin to take...it varies from person to person, and also depends on what I've eaten, how much exercise I'm doing (right now, with my bad foot, not very much), and the phases of the Moon and Venus. After enough trial-and-error, we'll have a much better idea of how this all works.

Oh, well, it's all part of getting better.

-Don

Political Ramblings Part 2

We went to whirlpool therapy today, and I actually managed to avoid a low-blood-sugar crisis by recognizing the signs and asking for juice before I passed out.

The foot is looking better each day. One of the four major wounds is almost all closed up, and two of the others are on the way. The fourth one, at the base of my big toe, still looks pretty alarming, but is healing satisfactorily.

Back to political ramblings for a moment. I have excellent health insurance, which has paid for everything so far except some co-payments on prescriptions. Good thing, too, because this whole episode has got to be well into the thousands of dollars. Just one insulin prescription would have cost close to $400 without my insurance.

Thomas doesn't have health insurance through work, the way I do. He has said, "If things were the other way around, and if this was me, I'd just have to die. I couldn't afford to live."

Yes, the health insurance situation in this country is all screwed up. But that's not what I want to complain about right now. I want to be a little more specific.

Thomas and I have been together going on 25 years, and have lived together for 20. Despite that, Thomas is not eligible to be included on my health insurance. Why? Because only couples who are married can have that particular benefit.

Let me count the ways this is unfair. First, it violates the principle of "equal work, equal pay." One of my straight coworkers can marry his or her sweet baboo, and get health benefits worth untold sums -- but I can't marry my sweet baboo.

Second, it makes bad economic sense. If Thomas were to get badly sick and need the kind of expensive care I'm getting, who would pay for it? First, the two of us would go bankrupt. Ultimately, the burden would fall on everyone -- further driving up the costs of medical care and insurance.

Third, it's not fair because Thomas is playing by the rules of being a spouse, without getting the benefits. I am at home only because Thomas is able to devote considerable time and effort to caring for me. Without him, I would probably have to be in a nursing home. And you can be sure that would cost a hell of a lot more.

Mark that, please. Thomas is saving a lot of money for everyone: the insurance company, my employer, society at large. He's helping to keep down everybody's medical costs. And what reward does he get? Nothing except the self-satisfaction of helping his spouse. He certainly doesn't get health insurance benefits.

So how does this incredibly unfair situation get changed? Allowing same-sex couples to marry is the most obvious way. The issue is now before the Maryland Supreme Court, but there's no confidence that they will legalize same-sex marriage. If recent court rulings are any guide, the best we can hope for is that the court will acknowledge the unfairness and throw the issue to the legislature. (The worst we can hope for is that the Maryland Supreme Court will rule the same way as Washington state, that all this unfairness is justified because "marriage" is reserved to straight people.)

If the court does send the issue to the legislature, Maryland may well wind up with the same sort of Civil Unions system as Vermont, Connecticut, New Jersey, and California. I assume that the enabling law would make civil union partners eligible for spousal health insurance benefits, so that Thomas would finally be included on my health insurance. But you can bet Don Dwyer and his ilk will fight that with everything they have.

There you are. If you live in Maryland, and if you would like Thomas to have a chance of surviving his next major illness...then please support our cause.

-Don

Catching Up on LOST

Yesterday evening we had a visit from Michele the Home Care Nurse. She recorded my vital signs, took some blood, and changed the dressing on my IV site. We'll be getting a visit like this once a week.

But my biggest accomplishment was catching up on back episodes of Lost.

When I went into the hospital, I was in much worse shape than I knew. Maybe it was the pain, the infection, or the various drugs...in any case, I was mentally sluggish and lacked the ability to concentrate on anything. At one point, someone gave me an issue of Newsweek, and I remember reading and re-reading each paragraph, trying to follow what was being said. (I repeat, this was Newsweek -- not exactly the most intellectually challenging fare. Maybe I should have asked for People.)

In short, I was only hitting on one or two cylinders, mentally. Fortunately, even on one or two cylinders I'm pretty high-functioning. I am very glad that I kept the wherewithal to smile, be pleasant, and thank everyone for all the things they kept doing for me. (Hint: If you are in the hospital, make an effort to be appreciative of everyone who helps you. These folks work very hard, and they get little thanks. It's the right thing to do -- but it also doesn't hurt to get the reputation of being a friendly, cooperative, and appreciative patient.) At one point I asked Thomas to buy a couple dozen donuts and bring them in for the staff as a thank-you...I heard about that for days.

(Hint #2: This isn't just true about the hospital. Everybody likes to hear "thank you, I appreciate the work you do.")

Anyway, back to Lost. I didn't fully realize just how dull my mind was, until about Tuesday or Wednesday of the second week, when the infection was finally on the run. It was only then that my mind started to clear, and only by comparison did I see how bad I'd been.

In addition, between morphine and Percocet, I had a tendency to doze off a lot.

So while I was sick and in the hospital, I didn't tackle anything that required much concentration and brainpower. My favorite TV programs were sitcoms that were familiar to me, like Friends and The Simpsons, or Discovery Channel programs like Mythbusters and How It's Made. Or CNN.

I certainly knew that I couldn't tackle anything as demanding as Lost. (Okay, it's not great literature, but you do need to concentrate and put things together in your head.) So I deliberately avoided it, even though I'm a big Lost fan. Luckily, Thomas recorded the three episodes I missed.

This Tuesday I watched the first of these episodes, and then yesterday I watched the next two. And the experience was as rewarding as I'd hoped. They were good episodes. This cleared the decks for last night's brand new episode at 10 pm, which I also watched (and also liked). It's a relief to be back to something resembling mentally normal.

(Of course, I'm still flat on my back most of the day, and still taking Percocet and another painkiller that make me drowsy, so I'm sure I'm not hitting on all cylinders yet. But I'm on the way.)

-Don

Some Polical Ramblings

Just back from whirlpool, which went well -- i.e. I didn't pass out. The foot is showing improvement, and they predict that the wounds will probably all be closed up within two weeks. Excellent news!

We've been chatting about this whole situation: nearly two weeks in the hospital and Thomas providing home care. And we've had a couple of realizations of a political nature, which we'd like to share. Today, hospital visitation.

We realized that we're very lucky we don't live in Virginia or Ohio, or probably several other states. If this had happened in Virginia or Ohio, if Don had been in the hospital in either of those states, then Thomas would not have been able to see him, accompany him to treatments and such, or act as his health care agent. In fact, if a Virginia or Ohio hospital allowed Thomas to do any of these things, the hospital would be breaking the law.

Why? Because Don and Thomas are a same-sex couple -- and in Virginia and Ohio, it is illegal to grant a same-sex couple any benefits that approximate the benefits of marriage. That includes hospital visitation, presence at treatment, and making health care decisions for the other person. In Virginia, this discrimination is part of the state constitution.

Luckily, we are in Maryland, where the laws are a little bit looser. Despite the efforts of people like Delegate Don Dwyer, Maryland has not yet passed obnoxious laws like those of Virginia or Ohio. And it seems unlikely that Dwyer and his ilk will find any success in their quest to discriminate against us.

We're still not safe, though. While Maryland has no laws against such things, it also doesn't have many laws positively protecting us. We're okay on the "health care agent" business, since Don can fill out a form designating Thomas as his agent.

Hospital visitation, though, is a little more in doubt. The Legislature passed a law specifically granting same-sex couples the right of hospital visitation -- but Governor Ehrlich vetoed it because it sounded too much like a step toward gay marriage.

So if a hospital decided that they didn't like gay couples, and refused to allow Thomas in to see Don...well, we would have no legal recourse. We're lucky that St. Agnes is a sensible and compassionate hospital; we might not be so lucky in the future.

One more thing: these rights of hospital visitation, presence at treatment, being health care agent -- these are all rights that any opposite-sex couple gains automatically with marriage. Two drunken fools who meet in Vegas and get married that same day, automatically have these benefits. Thomas and Don, who are going on 25 years together and who love each other beyond measure...we have to rely on the goodwill of the hospital to have the same benefits.

Is that fair?

-Don

Settling In

ABOVE: Here's Mr. Don getting his morning IV. Note the ivy on the IV stand. We had to buy that ourselves; it did not come with the stand.



ABOVE: Here's Nurse Thomas setting up the IV. Thomas's mother was a nurse; she would be very proud of him.

Well, we're both settling in at home and getting into a routine. Morning: IV antibiotics, several pills, insulin injection, and breeakfast. Afternoon: IV antibiotics, lunch, more insulin, and the thrill of changing the dressing on my foot. Night: IV antibiotics, a pill or two, dinner, insulin. Unscheduled excitements include staggering to the bathroom and back (with my cane), painkillers when necessary, and frequent naps.

Yesterday we went up to St. Agnes Hospital for my first whirlpool treatment as an outpatient. Whirlpool is a huge tub of water that swirls and bubbles, clearing out the bad stuff from the several wounds on my foot. It usually takes about half an hour.

Yesterday's session was a bit more eventful than usual. Maybe it was the exertion of hobbling down the long hallways, maybe it was sitting up on the high chair over the big tank, maybe it was an insulin problem...in any case, I had a low blood sugar attack and passed out for a few minutes. Thomas and the whirlpool folks were right there to help me, and in no time I was on a stretcher being fed juice and cookies, and getting my blood pressure and blood sugar checked.

It was quite a bit more excitement than I had expected, and I was very glad to get back home and into my sickbed. I slept for a few hours, then felt quite a bit better.

Such is the excitement of my life right now.

-Don

Mr. Don Has Been Very Sick

Hi, this is Don. I am online for the first time in about three weeks.

Here's the short version: I came down with my first-ever case of gout on Monday, March 12. After a week of ineffective tratment, my right foot got worse, and ultimately got infected.

On Monday, March 19 I went into Saint Agnes Hospital, where I stayed until Friday, March 30. The infection got very bad, and was resistant to many antibiotics. They made several incisions in my foot to drain bad stuff out, and put me on powerful IV antibioics.

Late on Friday March 30 I came home. I will continue on the IV antibiotics three times a day for the rest of the month. I will need to stay off the foot as much as possible until it heals.

As an additional complication, I have been diagnosed as diabetic. My blood sugar was all messed up in the hospital, and I am learning to deal with insulin and all that.

I am glad to be home, and feeling a little better every day. I am very grateful for all the cards, phone calls, visits, and wonderful things that my friends have done -- including coming over to help clear out the lounge so I can have a sick room at home.

I will try to keep up periodic updates here. Meanwhile, I'm sure I have a tremendous backlog of email; I will continue working through that but please bear with me.

Thank you! -Don