Wednesday, May 22, 2013

Surgery Update

I realize it's been a few weeks since my last post.  It was intentional.  Not long after my last post I received a phone call at work from Dr. Attinger.  A medical director with my insurance company, also a doctor, reached out to Dr. Attinger on the phone after we submitting the approval for the amputation.

My insurance company, through the medical director, will not approve the amputation until more documentation is received on five areas:
  1. Document loss of range of motion
  2. Document loss of functionality
  3. Document visits with multidisciplinary teams
  4. Document the five surgeries and the results
  5. Document emotional health and well-being 
Dr. Attinger reassured me on the phone that he 100% agreed with my decision and that we'd get this done, but that he agreed that this information needed to be documented.  

Fortunately, I've recorded all of this information on the blog!  I was able to pull together all of this information and send it over to Dr. Attinger's office.  I was hoping to update the blog after we received approval, but I think that's still several days away.

In the meantime, I saw my family physician, Dr. Kabatsi, last week for a physical and to update him on my plan.  After discussing with him my decision, he told me that he completely agreed.  The combination of poor bone quality and history of non-union combined with my family history of heart disease and high cholesterol indicate that amputation is the best possible solution.  He told me he sees several patients with ankle fusions who continue to suffer from pain and undergo revision surgeries.

He also told me that he's never heard of anyone choosing amputation over fusion or replacement.  Most patients go through with a fusion or replacement only to discover later in life that amputation is the best option.

So that's the latest.  I will keep you all updated once I hear any news.  Everyone seems to be optimistic that the approval will go through.

I should also tell you that I've found a prosthetist!  Elliot Weintrob at Orthotic Prosthetic Center in Fairfax.  It was awesome meeting with him and even more awesome that one of the amputees that commented on my post showed up for my meeting!  We got to sit down and talk for about 20 minutes.

I'm starting to find out that the amputee community is amazingly supportive.

Finally, I was recently reunited with my snowboard during a trip to Oklahoma.  It was the first time I'd seen it since I snowboarded into the tree on February 13th, 2010.  I expected the reunion to provoke anxiety and fear, but surprisingly, I was really excited and energized.

My helmet was still in the patient belongings bag from the park emergency room.

I was able to push my right foot into the boot and stand in it, but I couldn't bring myself to lacing up the boot.  I was afraid it'd start hurting.

There's basically no damage to the board.  There are a few bumps under the right binding where I hit the tree.  The park Ski Patrol told us "boards never break, only humans."  That is an accurate statement.

Tuesday, May 7, 2013

Surgery Six Scheduled

The Cookie Monster will make sense at the end of this post.  Word-smithing magic.

On Friday, June 14th, 2013, I will walk into Georgetown University Hospital with two legs and leave it a few days later with one.

That's in only 38 days.  I've got a growing to-do list before the gauntlet comes down.

Next week I've scheduled appointments with a pain management specialist, Dr. Netsere Tesfeyohannes, and my family physician, Dr. Didace Kabatsi, for a physical.  I know, it's an alphabet soup of doctor names.

I still have not locked up a prosthetist.  I spoke with Dr. Attinger's nurse, Kathryn, today on the phone to go over some questions I had.  While we were talking she reminded me that finding the right legman is important.  It's like a marriage.  Dr. Jeng said the same thing in March.

No pressure.  It's just the single most important decision I will ever make (behind marrying my wife, of course, and whether or not I should wear those jeans again).

"We use nine dimensions of compatibility to find your dream prosthetist!"

Finding "the right" prosthetist is a challenge.  I have no idea what the red flags are to signal a "bad" prosthetist marriage.  What I need is a dating website for amputees and prosthetists.  I posted a message on the Amputee Coalition of America's Facebook page to ask other amputees if they had recommendations for how to meet Mr. Right.  Because I have no idea what I'm doing.

Based on the responses I'm getting, I've noticed amputees will drive long distances to see a good prosthetist.  Several people, including Kathryn, recommended Elliot Weintrob at Orthotic Prosthetic Center in Fairfax, VA.  I'll schedule something with him tomorrow.  Amputees apparently fly in from around the world to see him.

But back to the surgery.

When I show up to the hospital in June, Kathryn confirmed I'll get my pre-game epidural.  Then, on Tuesday, we'll lop off the leg.  Once my pain is managed with oral medication, I'll be discharged and possibly admitted as an inpatient to the National Rehabilitation Hospital nearby where I will continue to learn I no longer have a right leg.  This will help reduce the likelihood of accidents when I return home.

Whether or not I'm admitted depends on how well I rehab.  And my genetic clumsiness.  I mean, we're here because I snowboarded into a tree.  When the Vegas odds-makers draw up the accident lines for me, there's no way they'll favor a clean record.

The amputation will be about 16cm below the knee.  Here's a picture to help put that into perspective.  This appears to be halfway, but it's actually much closer to the knee than you think because the foot is further away in this picture.

Okay, so this was a terrible picture to use.

One of the biggest items on my to-do list has been the oh-so-simple task of a total lifestyle change.  My wife and I started working on this in December when I finally decided I had had enough with this ankle.  In December I was a svelte 225 lbs.  For a guy that's 6'3", my body fat percentage was creeping past 27%.  That's several miles safely within the borders of obese territory.

My diet was awful for someone that had such a hard time working out.  I devoured all of the carbohydrates and processed food I could get my hands on.  The diet worked for me, so I thought, because I didn't have to spend too much time up on my ankle cooking.  Just throw in a box of frozen burritos into the microwave and enjoy life!

But all the weight I gained had the opposite effect.  My back pain, already bad because I can't push off with my right leg, got worse.  I stopped biking and lifting.  I began to worry I was stuck in a vicious cycle.

I lost hope of ever snowboarding again.  Instead, I was apparently training as Cookie Monster's backup, ready to come up off the bench at a moment's notice to eat frozen burritos (word-smithing achievement unlocked).

My wife and I drastically changed our diet in December.  And it's a permanent change.  Our new diet has a name, too.  Paleo.  I cook regularly and dominate at it.  And it's amazing how much better it tastes than that bean burrito in a box.  Many of our meals are vegetarian.  Since starting the diet, I've dropped 21 lbs.  My goal is to be around 195 lbs for the amputation.  This will make sure the prosthetic fits comfortably on my residual limb.

I also started working out again last month to ensure my core, legs, and upper body are all ready for the amputation.  I've been telling people that I will be in the best shape of my life after an amputation -- not before.

Getting an amputation has been the easiest decision I've ever made.  It's made the importance of diet and exercise more immediate and real.  But I'm not dumb.  I suspect this will be a hard decision to live with.  It's going to be really painful.  I know that.

But it will be worth it.