Home Forums Discussions General Discussion Carl's Blog On His Recovery From His Car vs Bike Encounter

I am going to have to make these posts worth one-half.

Oh come on it's Carl; at least give 2/3.

Hi Donna,

It would be nice if Kaiser simply stopped trying to discharge me, but Sir Humphrey would shake his head and call such hopes naive.

We must, of course, go through a whole new appeals process, with a new review of whatever documents are submitted.

And if my appeal is upheld, there is nothing to stop Kaiser from waiting two weeks and filing yet another mindless discharge attempt, despite nothing changing.

Meanwhile, Maddi is so pleased with how I wave 2-lb weights with my left arm that she has promised 5-lb weights on Monday.

Maybe I can drill holes in the 5-lb weights, sort of like a corked bat.

Cheers,

Carl

Hi Bert,

Surely a Medicare or Medicaid fee schedule could be adapted for those who keep score on posts.

Cheers,

Carl Fogel

Ouch! I think I will just stay away from this thread as clearly I am not witty enough to participate. Or maybe I will just focus on the quip and stay away from reparte. I can only hope I can slip away without dangling any participles, making an error in syntax or something as silly as a typo or grammatical error.

Hi Bert,

The Dangling Participles was the name of my English Department softball team.

Despite the unlikely presence of a former AAA baseball shortstop, we had a perfect winless record.

***

We can all forgive dangling participles, errors in syntax, and even amusing typos and grammatical errors.

But to omit the Oxford comma in a series of three or more items or phrases--well, that calls for pursed lips.

Your penance (wholly voluntary) is to return to a hero's welcome.

After all, to whom do we owe this board?

Cheers,

Carl Fogel

The Joint Articulating Splint was forgotten until I prodded Kaiser.

Reading the reply, I wish that I had left well enough alone.

A mere 2-4 pain level on a scale of 0-10 is recommended:


"Typically the JAS rep who fits the pt with the splint will talk about usage and protocol, but sounds like that was missed this time. "

"They are supposed to use the JAS splint for 30 min, 3 times a day for each direction they are working on. They are to adjust the splint for slightly more stretch approximately every 5 minutes during that 30 minute timeframe."

"When using the JAS, it should be a stretch, but not overly painful- they recommend a 2-4/10 only on the pain scale."


I have three business days to plan my escape before Torquemada arrives.

Carl,

Oh my, that certainly sounds like a modern torture device.

Is your powered wheelchair speedy enough to make a quick get away? Should we send you a disguise?

You will be happy to know, I am paying close attention to my grammar these days, especially the comma. Feel free to correct any slip ups.

Hi Donna,

Slip ups? Please, the hyphen is our friend! I can only pray that its omission was a typo!

With that out of my system, on to more serious matters.

The internet informs me that the great circle route from my temporary residence in Littleton to stately Fogel manor in Pueblo is 113 miles.

My electric wheelchair claims a 24-hour charge.

When I retract the footrests, lower the seat, and put the back upright, a little fiddling with the wheelchair's controls allows a blazing outdoor top speed of 3.8 mph (3.7 mph against the winds on the gentle uphills).

(Naturally, I shift down to the 2.3 mph indoor speed-range inside the facility to spare the lives of innocent staff.)

Unfortunately,24 hours x 3.8 miles per hour gives me a distance of only 91.2 miles, give or take a few furlongs, far short of the required 113 miles.

Drop tanks solved this range problem for P-51's escorting bombers over Germany, but wheelchair technology is still in its infancy.

So instead of escaping, I'll have to stay where I am and let Maddi the Occupational Therapist bend and straighten my arm with the frankly medieval dynamic arm splint whenever it arrives.

Cheers,

Carl Fogel

Ha, Carl, I actually looked it up before I posted.

This is what I found:

slip up
vb (intr, adverb)
1. informal to make a blunder or mistake; err

If it's missing a hyphen, then the source was wrong!

Well, you must concentrate on the lovely Maddi, and not the 2-4/10 pain that the device will evoke.

Uh oh,

The same source, The Free Dictionary, also gives this, the noun. DRAT!

slip-up (slĭp′ŭp′)
n.
An error; an oversight.

Hi-Donna.

Uh-oh . . .

Cheers,

Carl-Fogel

That damned hyphen!

Apparently, I have forgotten more of my basic English than I realized….

Don-na

Hi Donna,

Er . . .

Never mind . . .

Back to matters of more interest than the space-bar . . .

Maddy (her preferred spelling, short for Madison) the Occupational Therapist had a wonderful time measuring my arm for the dynamic splint, measuring from my wrist to various points on my elbow several times to be sure that she had everything right..

She's like a child expecting a Christmas present, partly because she's never done this sort of thing and partly because she'll get to crank the splint tension up until I shriek "Uncle!"

Cheers . . .

Carl . . . Fogel

Carl,

Ok, ok, Uncle! I accept it, my grammar has gone to hell, 3 spaced periods for the ellipsis.

And, Maddy previously sounded like such a nice person. . .

Hi Donna,

Previously I sounded like such a nice person, didn't I?

But then I tore off the mask and revealed my true nature, quibbling about punctuation.

Maddy is in fact a nice person, but she is also an Occupational Therapist, the equivalent of a drill sergeant.

She doesn't shout for me to drop and give her twenty when we pass each other in the hallway, but I fear that today she's going to be so pleased with my progress that she's going to give me a heavier weight to wave with my good left arm.

But Maddy's regimen works--my left forearm has lost most of the more outrageous atrophy wrinkles from two months of idleness. There's even a faint outward bulge at my left elbow, quite the opposite of the inward curve on my withered right forearm.

However, I won't inflict more niggling corrections about utterly trivial punctuation--everyone here writes perfectly legible posts, so there's no need to fuss about our friend the hyphen, no matter how much the degenerate freshman English teacher in me enjoys it.

I hear noises that suggest breakfast is about to appear, followed by Matt the Physical Therapist, who is a good fellow, despite his habit of pulling my ankle toward my rump until I cry uncle and then holding the ankle in that painful position for 30 seconds. Unlike fussing about inconsequential punctuation, this is probably good for me.

Just as Maddy can't wait to try the fiendish arm splint, Matt is eager to get me face-down on the hospital bed so he can, as he puts it, really lean on my bent legs.

Cheers,

Carl Fogel

This morning in front of a breathess crowd ((well, in front of Matt the Physical Therapist), I sat on the edge of the hospital bed and stamped on a weight scale with my right hind hoof.

Not much happened, so Matt adjusted the height of the bed a few times, and I finally put 40 pounds on the scale for a minute or two, a quarter of my body weight.

Emboldened by success, I later dragged the shower chair away from the toilet using my right foot, washed my hands in the sink, and slowly emerged triumphantly on my own from the bathroom instead of being pushed by a CNA (who wanted to know what I was doing out loose on the shower chair's little shopping cart wheels).

Tune in next week for the daring attempt to reach 80 pounds.

Carl,

I am glad to hear of your progress! You are certainly working hard for every bit of it! Has your torture splint arrived?

Hi Donna,

The splint should arrive at the local representative's office by dog-sled next week, whereupon he'll hammer out the details of when my fitting will occur in the presence of Maddy, who will in turn reluctantly train various staff in how to apply and remove it three times a day. I fear that Maddy will be disconsolate when she realizes that her busy schedule will not all her to turn the crank every time.

Meanwhile, Kaiser has filed its 4th notice to discharge me, apparently on the grounds that it's been two weeks, for heaven's sake!

On a brighter note, I spent 4 minutes at 40 pounds on mybent right leg, leaning over the edge of the bed onto a walker with my left arm. There may be all kinds of equipment for one-legged and one-armed patients to put weight on their increasingly good leg, but the facility doesn't have them.

Most of my more ridiculous Rube Goldberg schemes go like this:

1: Somehow get into place on the equipment.

Hmmm . . . that first step needs a little work.

Cheers,

Carl Fogel

Carl,

Certainly two weeks is enough to be fully up and running, isn’t it? I was hoping that they would leave you alone after realizing their mistake the last time.

I am cheering on your progress!

Hi Donna,

Three kinds of recent progress:

Back on the pills for muscle spasms and "nerve pain" (what other kind is there?) after my foolish attempt to stop taking them, which lasted one night. Maybe they aren't the placebos that I took them for?

Swift review and denial of our routine appeal of Kaiser's 4th attempt to discharge me. Now we're in the "reconsideration" step, where they have to explain why they want to discharge me. It takes longer, but is more entertaining.. (It's sort of like a traffic cop stopping you and handing you a ticket that doesn't say why he's ticketing you, your first request to dismiss the ticket is denied without any explanation, and then you go to court and they finally have to explain that your offense was speeding when your car was parked, which leads the judge to laugh and dismiss the ticket.)

More weight-bearing at 40 pounds on my right leg is wonderfully easy after I simply raised the hospital bed much higher so that the leg is almost straight instead of being bent. The button to raise the bed is hidden from the patient on the other side of the control panel, but I learned months ago how to feel for it.

Cheers,

Carl

Carl,

Yes, better living through chemistry, stay on whatever you need to control pain in order to continue your rehab.

I am glad that you can find some entertainment in the denials, it certainly doesn’t sound amusing to me.

The hand and elbow doctor was right when he said that I wouldn't like the dynamic splint.

It finally arrived two days ago, delivered by the local rep for the company, a very nice fellow, well-spoken and clear, who trimmed and padded the damned thing on the spot to suit my atrophied right arm.

Maddy the Occupational Therapist gazed with il- disguised lust at his single tool, a pair of what looked like ordinary stainless steel scissors.

They turned out to be $30 Italian scissors, apparently favored by people who work with casts and plastic medical fittings.

They did make nice clean cuts in the 1/8th inch plastic without much effort.

(I watched with interest, since I'm having a hard time just pressing fingernail clippers with my enfeebled right hand.)

The splint is a simple V-shaped contraption. You lash your arm into it with some velocro straps and buckles with your elbow point down in the middle and turn a knob to spread or close the V, stretching or compressing the reluctant arm.

There are three problems so far.

First, Maddy worries that my sensitive flesh is not getting along with the padding because it leaves red marks on my skin.

My suggestion to put some plastic wrap over the offending padding was cruelly dismissed on the grounds that it would trap moisture and cause even worse problems. (I was tempted to tell her that I have vision and the rest of the world wears bifocals, but I fear that she's too young to remember what Butch Cassidy said in the movie.)

It may just be the pressure, not true skin irritation.

Second, I'm supposed to find time to do 6 30-minute sessions every day, with 45 minute intervals between each session, three stretching and three flexing. Doing a pair before and after breakfast, lunch, and dinner might work, except that I also have to find time for 45 minutes of leg exercises and 30 minutes of dumb-bell exercises with my good arm.

(Maddy was horrified when I dug up an out-of-date set of instructions that recommended wearing the damn thing at night while asleep.)

Third, the whole scheme relies upon the simple and intuitive notion that I can tell when things are stretched far enough, but not too far. Both the rep and Maddy repeatedly warned me not to over-do it, just enough to stretch things alittle.

So I'm somehow supposed to know how far is far enough.

This reminds me a little of Adam Diment's spy-hero Philip McAlpine's comment on a learn-new-languages-effortlessly scheme that was supposed to teach him fluent Russian in his sleep: the evaluation suggested that "either the method, a French importation, was grossly over-rated or else McAlpine, P. was an idiot."

Either the dynamic splint's tension-level is harder to figure out than advertised, or else Maddy is writing in her chart notes that Fogel, C. is an idiot.

Ten more minutes until I can take it off.

Carl, you are teaching me to never complain about my job. At times I may have long hours, but the true torture sessions are few and far between.
On the other hand, you are supposed to work long hours, and it sounds like pain is a regular companion.
You have our empathy and concern...

A friend had a recovery with some similarities. He developed Guillain-Barre Syndrome. This is a rapidly paralyzing neurologic condition which can be fatal or can leave the patient with paralysis. One day you are fine; the next day you cannot move, and breathe with a ventilator. He was fortunate enough to survive, with a recovery that included PT, OT, and exercise that was intensive and often painful. A major issue was the muscle atrophy and subsequent joint deformity from the paralysis. He has some relatively mild disability now, but is nearly totally functional. Hopefully you can achieve the same.

I bring this up because we know your "new job" is a painful one, but there is hope that the outcome will be favorable.

Hi Jon,

Joseph Heller (Catch-22) wrote about his bout with Guillain-Barre.

Your friend suffered a lot more than Heller, and a lot more than I will with my mere limb fractures.

The opiates took care of my first two weeks after surgery.

After that, I didn't need those pain-killers.

So my enforced vacation hasn't been painful unless I move wrong--then my left leg or right elbow protest, and I stop.

My range-of-motion exercises are tedious, but don't hurt.

Even the dynamic splint that stretches and flexes my right arm is just uncomfortable, not painful.

After the first session, I forgot to take my precautionary tylenol, which shows how little I fear the splint.

Hell, I spent one session today chatting with my sister on my cell phone.

The same is true of rocking my right foot to make the needle on the scale bounce from 80 to 90 pounds while I perch on the edge of my bed for 6 minutes--it's tiresome and boring, but not painful.

In fact, I feel like a fraud when kindly friends and relatives praise what they mistakenly think is my hard work and suffering.

And this feeling gets worse when I roll past the neurological patients where I am.

I'm mostly sitting around and waiting for the screwed-together bones to grow solid again.

If this is a job, as you put it, it's featherbedding--I loll in bed, they hoist me into the electric wheelchair, I play on the internet, do some exercises, and put the dynamic splint on. When they ask about my pain level, I have to tell them zero.

***

In contrast, the Australian author Robert G. Barrett turned out the essay linked below about his awful medical struggles.

Christ, how he suffered!

Barrett wrote decidedly not-safe-for-work novels that ripped right along, mostly about Les Norton, a bouncer for an illegal Sydney casino. Barrett didn't worry much about plot or plausibility (I remember two nuclear bombs and more than a few supernatural deus ex machinas), but he had a cheerful vulgarity that made his books sell well in Australia.

The first five long paragraphs of his memoir below, "Bowling for Bukowski," taxi along gently as he explains that he's going to try to write like Bukowski, and then things take off with the opening line of his own not-safe-for-work story:

"The [censored] hit the fan for me in late 2008."

https://drive.google.com/file/d/1SkXD2AfSZ_MK6DxYWxcNlBVYIS1Y0bBq/view?usp=sharing

(Google drive displays it as a text file in notepad, goofing up the apostrophes and quotation marks. As Barrett would say, I can't be arsed to fix them, since you can change to wordpad, which dsiplays the punctuation normally.)

(And no, I don't think that asparagus juice will cure anything--Barrettt was just understandably desperate.)

Anyway, re-reading Barrett's oddly hearty account of his misery reminded me just how lucky I am.

Cheers,

Carl Fogel

Aha!

The independent KePro review company has denied Kaiser insurance's 4th mindless attempt to discharge me.

Admittedly, KePro upheld Kaiser on my first appeal before changing its mind on my second appeal.

(Actually, my sister takes care of the appeals while I loll in bed.)

I wonder if Kaiser just tries to discharge patients every two weeks without bothering to read the charts?

***

In other news, I'm not afraid to change my mind.

I now hate the damned dynamic splint, which hurts now, but is slowly forcing my hand toward my shoulder.

The ugly trick is to crank it up a notch tighter every five minutes when things stretch and bother me less.

***

I also learned that the recorded message at Kaiser's Denver site isn't joking when it urges callers to change any Monday appointments because Mondays are very busy.

I left by ambulance at 7 a.m. Monday for a routine follow-up exam at 8:10 a.m. and returned five hours later at noon.

***

On the bright side, I have two different schemes for putting 75% of my weight on my right leg that will astonish Matt the Physical Therapist.

(Probably he'll be astonished by how foolish I am.)

And next week I start putting weight on my left leg while wearing a stylish brace to prevent any wobbling.

KePro rejection.....In OUR case, KePro upheld UHC's Medicare "Disadvantage" determination that a 93-year-old man (my father-in-law) with a replaced hip post-fracture and dislocation, was good to leave rehab after 3 weeks, even though he couldn't even walk without a walker AND assistance, and there was no one to help him to the bathroom and other ADL at home. We paid the bill for further rehab ourselves (perhaps ill-advisedly) and are in the multi-stage process of back-and-forth with Medicare advocates, the rehab center, and UHC, who are, naturally throwing every obstacle in the book at us in their attempt to withhold benefits.
Crazy medical insurance system we have here in one of the richest countries in the world.

Carl,

Glad to hear that the discharge attempt has been quashed for now.

I am sorry that the splint is painful, but, hopefully, it will be worth it in the end.

And, it sounds great that soon you will resume being a biped. Onward!

Hi Donna,

Today I learned that collarbones are apparently optional.

I've been waving a dumb-bell around with my left arm without any problem for a few weeks.

https://1drv.ms/u/s!AnkDjbadiwV72BHOVB0kGuRcT9fr

Above is the x-ray from Monday.

Cheers,

Carl Fogel

Hi Kurt,

Yikes!

You have my sympathy.

It sounds as if I've been luckier than your poor father-in-law.

You may have tried it, but beyond the mere "appeals" there's what KePro calls "reconsideration."

In my case this meant that either the KePro doctor rules against the insurance company or else they provide in writing the specific reasons for the discharge, which gives you something to work with.

Good Luck,

Carl Fogel

Wow, Carl, that is quite an XRay. That wasn’t previously diagnosed?

Hi Donna,

To use medical lingo, the distal fracture escaped the notice of the patient for years until a car hit him.

The diagnosis was that the patient is dim-witted.

***

The proximal fracture was fresh and new on March 29th and was beautifully reduced at that time.

(No x-ray available, but it was just a crack in the clavicle.)

**

By May 3rd, things had deteriorated:

https://1drv.ms/u/s!AnkDjbadiwV72BJgqr45mcK5XYmA

***

By June 28th, things had gone completely to hell:

https://1drv.ms/u/s!AnkDjbadiwV72BHOVB0kGuRcT9fr

***

The patient still hasn't noticed any problems, so the original diagnosis remains unchanged--he's still dim-witted.

Cheers,

Carl Fogel

Carl,

I can’t imagine how that is asymptomatic!

Hi Donna,

Like you, I think my broken collar bone ought to hurt like the dickens, but it doesn't.

One doctor wondered off-hand if there might be nearly invisible scar tissue bridging the original gap in my collar bone, so I suppose he could be goaded into speculating about new scar tissue spanning the new gap.

https://1drv.ms/u/s!AnkDjbadiwV72BHOVB0kGuRcT9fr

But even if there's nothing connecting the three pieces of my collar bone, it doesn't hurt when I wave my pitifully small dumb-bell through three daily sets of eight exercises, ten to twenty times each, overhead, to the side, out in front, and so on.

Maybe a heavier dumb-bell will wake my collar bone up. Or the back-stroke.

***

Meanwhile, my right leg gives abrupt, ugly twinges with 75% of my weight, but today I put 25% of my weight on my left leg without any trouble, possibly due to a handsome knee brace, a crutch under my left arm, the edge of my bed, and some unknown weight on my right leg.

Matt the Physical Therapist is afraid to let me try my simpler scheme to dangle from the ceiling in a parachute harness until my right foot touches the weight scale, claiming that he has no parachute harness handy--a feeble excuse!

Cheers,

Carl Fogel

Matt the Physical Therapist startled me yesterday by saying no leg exercises, something new today.

Stand up!

Brace on left leg, most of my weight on right leg, left hand on weird semi-walker, heave up, and slowly straighten hips.

Strange to be up so high after three months--looking forward to seeing all the nurses and CNA's shrinking from my lofty height.

Well, not Maddy the Occupational Therapist--I estimate her at six foot four.

Having stood up ten times, I moved on to transferring from bed to wheelchair--no more dangling from the little crane!

Maddy appeared, apparently because transfer from wheelchair to toilet lies in her realm.

She decided that the toilet was too low and put a commode chair over it, even though I was sure that I could have done it.

More success!

Matt put a slight damper on the festivities by saying that it will be four more weeks before I start walking instead of just towering motionless like a statue over the staff--my two legs and left arm combined are enough to stand, but neither leg is up to handling my full weight yet.

Cheers,

Carl Fogel

Carl,

That sounds wonderful that you are upright! It’s a miraculous achievement after the injuries you sustained and many months of recuperation.

It’s very good to hear of what sounds like steady progress!

Congrats, Carl. A MAJOR achievement.
Keep at it... (as if you have a choice).

Last Friday, Maddy the Occupational Therapist watched sternly as I transferred from the wheelchair to the commode over the toilet.

Maddy softened a little when I didn't fall on my face on the bathroom floor and said that I might be allowed to transfer from bed to wheelchair unattended on Monday.

It's like being promised the keys to the car at sixteen!

And like an idiot teenager who forgot to take the parking brake off, I have to confess to Maddy on Monday that I forgot to put my leg brace on today.

In my defense, all three of my morning transfers went very smoothly.

Somehow I doubt that Maddy will think much of my excuse.

Leg braces should come with something like strings on mittens.

Carl,

Glad to hear of your continued progress! What's next?

Thanks, Jon--I appreciate your good wishes.