Wednesday, 30 April 2014

Pitting Oedema

Physiotherapy has started. I thought it would hurt like heck, but remarkably, she was very gentle.

After reviewing all my particulars, she said our primary focus was reduction of swelling and improvement in range of motion. My foot below the ankle is still pretty swollen, and she helped me understand the state I was in.

Swelling (oedema) results from the buildup of fluid in the tissues. Initially fairly liquidy, the fluid causing the swelling, over time, becomes more viscous if the swelling does not subside. The goo in my foot is about the thickness of toothpaste, so much so that my current state is called "pitting oedema". Push into it with your thumb, and the impression (the "pit") stays there for minutes. A few days ago, I took the ice bag off my leg, and it left a noticeable dent. I was worried I wrecked something, but apparently, it's kinda "normal" with the degree of swelling I have.

The fluid build up in my foot is a result of a thick band of tissue that crosses the ankle that holds down the tendons and ligaments. The only way fluid can escape is under this band, but the fluid is so thick, and the space so small due to swelling, it won't drain.

She took measurements of my swelling, then treated my foot like the bottom of a toothpaste tube, endlessly squeezing the toothpaste out past my ankle and up to the lymph nodes in my calf. Lymph nodes get rid of guck like this, though I'm kind of overloading them these days.

In 15 minutes, my swelling was reduced by 40%. I think she could get the last drops out of a tube of anything.

With less swelling, she went after my ankle range of motion. 15 minutes of stretching and rubbing, and I got a 15° increase in flexion, and 10° in the extension range. That moved me from about 5% of "normal" range of ankle movement to 50%.

She taught me 4 new strengthening exercises, and 4 new stretches to add to the regime started in the hospital last week.

Something tells me not all sessions will be that dramatic, but it's a start. Now all I have to do is actually do my exercises.

Saturday, 26 April 2014

The Cost of Cancelling Africa

Okay, let's be clear, our Africa trip is not cancelled, just postponed. But to when we are not sure. If we knew when, then we could reschedule dates, and this process would be different. But we have no new date, and are running up against deadlines for cancellations. And so we cancel.

1) The Safari

Booked through OverlandAfrica, our tour with is with Nomad Adventures. Nicki at Overland has cancelled our seats, and is searching for alternative dates. There will be a fee of about $350 to move to the new dates when we find them. That's about 5% of the tour cost

2) Flights there and back

As luck would have it, our flight from Calgary to Cape Town, and our flight from Johannesburg to Calgary, were booked on Aeroplan points as separate one-way tickets. This is actually good.

Because we are more than 22 days from flying home, the flight home was just cancelled, the Aeroplan fee, all $594 in taxes and fees, and the 150,000 points were all credited back.

The flight there is different. Within 22 days of departure, all the above happens, except... the refund comes in as a credit that must be used against another Aeroplan reservation that must be booked and ticketed prior to January 2, 2015. This includes a pre-payment of $415 in taxes and fees. It will cost $180 to apply this credit at the time of booking. 

Okay, so this probably isn't a bad deal. We'll either use the credit against the revised Africa flight, or if that can't be booked prior to January 2 2015, we'll use it to get to Maui.

Had it been booked as one round trip, everything would have come back as an Aeroplan credit, and there would have been a $360 charge to re-book.

3) Flights in country: Victoria Falls to Port Elizabeth

We booked flights from Victoria Falls (Livingstone, actually) to Port Elizabeth at the end of our safari with South African Airways though their website. Of the $673 US fare, the cancellation charge is 1,850 Rand, or about $191 CDN (25% of the original fare)

4) Flights in country: George to Johannesburg

We booked this flight through Kululu, a low cost carrier that's a division of British Airways, on the website. This $195 airfare is non-refundable, period. It can't be cancelled. It allegedly can be changed, for $62, right up until 2 hrs before we were to depart (June 2). However, I can't figure out how to change it on the website.

5) Hotels Part 1

Normally, I like to book as directly with a hotel as I can. In this case, we broke that rule, and booked Cape Town, Port Elizabeth and Wilderness through Bad choice, based on the cancellation policies.

Cape Town: Hotel was to cost $259. Cancellation charge $51 (20%)
Port Elizabeth: Hotel was to cost $145. Cancellation charge $0
Wilderness: Hotel was to cost $124. Cancellation charge $62 (50%, cancelled 24 days after the booking, and 40 days before arrival). That seems excessive.

6) Hotels Part 2

We booked our hotel in Knysna directly. Hotel was to cost $95. No charge to cancel since we did so more than 48 hrs in advance.

So the total cost to cancel/move this trip has been:

$350 + $180 + $191 + $195 + $51 + $62 = $1,029

I had thought my Amex Card covered me for some of this. Answer: no. They took trip cancellation insurance off my Gold card 3 years ago, and it's now only included in the Platinum card. The Gold Card has Trip Interruption insurance. So had I broken my leg in the middle of the trip, cancelling from that part forward would have been covered. But because I broke it before I left, no coverage.

Friday, 25 April 2014

The recovery has a delayed start

Strikes me that if I'm stuck here in bed for the next 12 weeks, I may as will bring you on my journey.

When last we left, I was discharged from the hospital on the morning of Sunday April 20, a day later than they thought I would get out. I went home via my pharmacy to pick up drugs and ask a bunch of questions. I was on 2 percoset every 4 hrs (plus gel ice packs), and got home in time for the noon dose.

As the afternoon progressed, I struggled to get comfy, and had to move a few times. My pain was climbing through the 3-4 range. The 4 PM pills didn't improve things. A friend came over to make us dinner, and by dinner time at 8 PM my pain was up to about a 7. I joined them at the table, leg elevated, and started to feel a lot worse. Immediately after dinner I laid down, and the pain just continued to get worse. The 8 PM pills achieved nothing. The pain after dinner was at a 10 and I was in tears.

At 9 I broke down and called our Provincial nurse on-call service. They took my info and said "get thee back to the hospital NOW". I was there just before 10, and taken immediately into an essentially empty ER. The on-call doc came and looked me over; because of massive swelling below the knee, he was extremely worried that I was showing classic signs of Compartment Syndrome, a very bad complication. So worried that he called in the on-call ortho doctor and an entire OR team to start getting prepped.

Around 11:30 PM, the team was there as was my ortho doc again. Ortho Doc 1 (the one who did my surgery) wasn't so sure that it was Compartment Syndrome. To test, he constructed a medical barometer, drilled a hole into my muscle compartments with a horse needle, squirted in some saline, and watched it rise in the tube as it squirted back out. I was at the extreme high end of normal pressure. Since Compartment Syndrome surgery is very invasive, he didn't recommend it, but did want me to stay.

It was an uncomfortable night with a whole lot of morphine. The pain came down to some manageable levels, but spiked in the morning, and I spent an hour or more at an 8-9 pain level around 8 AM during an ice bag change. Ortho Doc 1 was off for a week, but his partner Ortho Doc 2 came to see me first thing. He wanted me to start working my muscles to get the swelling down.

In came Physio Lady around 10 AM Monday to give me a list of things she wanted me to do, one of which was to increase my leg's elevation. She stuffed a huge wedge under my leg, and I started limited range of motion work. Within 2 hrs, my pain was off the map and I had used up all my self administered morphine. We pulled the wedge, and things took a couple of hours to get manageable.

In the middle of the day on Monday (while things did not feel that good), I saw a note from someone at the Friends of Kananaskis. The newsletter, for which I was responsible, and for which I had spent ~6 hrs getting ready to release the week before, and trained someone last month to release without me, was "done", and ready for final checks. I looked at it. It sure wasn't what I had put together. I talked to the person who worked it; they had made a mess and tried to recover, teaching themselves in the process. So I scrambled for an hour on-line through a slow connection on my iPhone's personal hotspot to fix it. I got the most egregious bits fixed, and got a lot of frustration in the process. This got Ortho Doc 2 mad at me, telling me at one point to "put down my computer and get better". Very frustrating since I put in so much effort to make sure this exact experience wouldn't happen, and trained someone exactly how to do it (someone else unfortunately did it instead, though I have to acknowledge they tried to step up and help).

I had a couple more pain spikes on Monday in the evening, including one call to the nurses for help -- though there's really not much they could do other than tell me I had pumps left on my morphine. I had hopes for a half decent night's sleep but it wasn't to be. I got a couple of hours between 4 AM and 6 AM and that was pretty much it. The morphine, I had concluded, wasn't controlling pain, but it was putting me to sleep.

I was cleared to shower on Tuesday morning. It was a complicated and painful procedure. Even shaving required hedge trimmers. I was a mess, and pretty sure I didn't smell all that good. Cleaning up made me feel much better.

And I got visitors Tuesday, so it's a good job I showered. Among others, my friends Don and Helen drove from Invermere to Calgary, bought Karen and me a take-out dinner from Lina's Italian Market there, and then came back to Banff to visit! The food at the Banff Mineral Springs Hospital is fine, but real food was a treat. Plus, the hospital serves dinner at 4:30 PM (4 hrs before my normal dinner time). Karen and I picnicked in the room at a reasonable 7 PM. My pain was mostly under control, Ortho Doc 2 happy with my progress (so long as I didn't spend time working on my computer). We discussed weaning off the morphine and moving to percoset again with the nurse. After Karen left, I got a nap, then at 10 PM the morphine drip was disconnected. At my midnight check, the pain was growing, but manageable and I was wide awake. I mentioned that I missed the morphine because I could have used it to go to sleep.

That's when my nurse mentioned that I had been prescribed Ativan, a sleeping pill. Sure, tell me now. At 1:00 AM, I took them, and the next thing I knew... was 7:30 AM Wednesday. I didn't know where I was. I was awoken by an oriental lady in a mask taking my blood. It occurred to me I had been kidnapped. I looked at my phone and knew from the display I was still in Canada. My leg was heavy and weighed down by bags; I couldn't move it without it hurting, and I didn't know why. I opened the drapes a bit with a crutch I found leaning nearby and looked out and saw trees and mountains. I couldn't imagine where in Canada had trees or mountains. It was quiet, and the room was a bit of a mess. I thought I was being held by Chinese invaders in a disused closet full of junk.

One of the side effects of Ativan is hallucinations.

It only took a half hour to figure out where I was and what I was doing there. Unique. Karen called at 8 AM and told me I sounded "chipper". The next 2 hrs is a bit of blur. Another of the of the side effects of Ativan is memory loss.

At 10, Karen arrived, and back to normal, I showered myself, and by 11, was ready for discharge -- except the hospital wasn't. They forgot I was being let go. I needed prescriptions to take home, and so there was a bit of a scramble to get those.

Home, fed real food, struggle to figure out how to be comfortable, and how to do stuff I needed to do to live. Wednesday night was a full of experimentation to figure out how to sleep, exacerbated by 1 AM and 5 AM wake up calls for meds, plus my cat visiting at strange hours to inspect and climb on this leg sticking up in the air where he usually slept.

Thursday morning Karen and I had a meeting regarding "stuff" we still have to do. We still have Africa flights to cancel, including the flights there and back. My roof is still leaking, due to skylights that need fixing. I still have to do our taxes. I was supposed to go to meetings this week, basically none of which I can physically make (Wildlife Ambassador training, Bow Valley Stewards project planning, Condo Board AGM, monthly Friends of Kananaskis Board Meeting, among others). And it doesn't help that I'm personally only running at 20% efficiency at accomplishing things.

Last night's sleep was better. We moved the med timing forward a bit, so for my early meds, I had not fallen asleep yet. I was ensconced in sleeping when at 3 AM...

...the cat came in. With a mouse he had caught.

I wrote last fall about us getting in an exterminator to get rid of our mice. They normally offer a guarantee of no more mice after their work is done, but couldn't in our case as they did not have access to see 100% of our foundation walls around the house because of a particular deck being in the way. We caught a mouse on April 12, and got the exterminator dudes to come back on April 15. They found another way for the mice to get in (that they should have found last time) and sealed that one up, too. So having another mouse show up (that my stupid cat could catch) was not on my list of "things to do". Now we have to get the exterminator dudes back a 3rd time.

Welcome home. Only 5 more weeks of zero weight on my leg.

Sunday, 20 April 2014

An unlucky break

Winter has still been hanging in here, certainly up at Sunshine where I ski. I like skiing in the winter. I'm not a huge fan of spring skiing, which is why we always plan a trip in May, after the SnowHost season is over, while the skiing conditions become spring-like, and before you can go out hiking.

Looking at the weather last week, the forecast was for a bunch of fresh snow on Wednesday, so Karen and I decided we would go up skiing on Thursday. However, Karen got sick with a cold on Tuesday, spent Wednesday not feeling the best, and Thursday in bed with me playing nursemaid. In the meantime, 20 cm fell on Wednesday and Thursday, so I was itching to get up to the hill. When Friday came, she was still very, very sick, and at 8 AM said she wasn't coming with me. I headed off to ski alone.

It was a great day, snow wise, less so visibility wise. Occasionally socked in with a white-out, most of the day was overcast with OK viz. So I was staying near trees, playing in glorious 25 cm deep untracked powder.
A 25 cm test in the South Side Chutes
What it skied like
Here's why not being near trees was good.
Bye Bye Bowl. 25 cm but no viz
I actually got a chest shot in the lower part of Bye Bye, but I deemed skiing there just too dangerous, and I wanted to ski conservatively because I was on my own and am going to Africa in 12 days. So I decided to head back to Goat's Eye, and to take one of my favourite routes through the Lower Rock Ledges, where no one rides, the powder accumulates and the trees give you viz.
The entrance. Good viz, 25 cm untracked. 1:05 PM.
Normally I ski in and take a picture. Friday I didn't, so here's a photo of the route I use taken on an earlier day.
Mar 21, with similar powder & traffic, but sunny.
I skied into this point and stopped, checked for traffic coming down from above, and started down. In 2 turns, I was near the trees in the centre left of the picture, in powder over my boot tops. I was not going fast.

I recall noticing a bump in the snow, which are only ever caused by something under the snow. Turns out that bump was a tree, possibly a branch of a short tree. Unbeknown to me, my right ski went under it. It caught my boot at the instep, and the boot and ski stopped. I didn't. I pitched forward and crashed, my right foot firmly jammed under the tree bit, breaking my tibia.

Well, THAT hurt. My first aid training kicked in. Looking back towards my foot, I could see my lower leg canted forward at the boot top. I forced myself to get calm, control my breathing. I was able to use my pole to get my left ski off. I was pitched down the slope, putting a lot of very painful pressure on my right shin. Once my right ski released, I used my left boot to step on my right binding to free my boot, though it was still jammed under the tree bit, and I was kind of hanging from it.

I was able to get out my cell phone and tried to call Dispatch to get Patrol. But right there, I had no cell service. I tried a few times and gave up. I carry a whistle for just such emergencies, for as I have written elsewhere, you can scream for about 2 minutes, but you can blow a whistle all day. I blasted out SOS about 3-4 times. I was visible to and within shouting distance of the Angel chair. Someone called out that they would get Patrol. A couple of minutes later, I saw a Patroller riding up Angel chair with a sled. He called out to me that he was on his way. Other riders appeared on the run and offered assistance; I asked them just to stick around until Patrol came.

A couple of minutes later, Troy, the first patroller arrived. I know many of the Patrollers on the hill, and Troy is no exception. Troy cut my pants a bit to expose the site and confirmed that I had broken my tibia. He called for a sled, and after a few more minutes, my Patroller friend LC arrived. I was loaded into the sled, and skied down to TeePee Town, where a skidoo picked us up and pulled me to the Infirmary. Note: skidoos smell bad and kick up a lot of snow when you're riding behind them.

There was an on-call doctor in the Infirmary, and between LC, Troy and him, plus a bunch of nitrous oxide, they got my boot off. He confirmed that my break was a pretty bad one and would almost certainly require surgery. I called Karen to come get me to take me to Banff Mineral Springs Hospital. I could have taken an ambulance, but didn't see the point (and they're expensive). They packaged me up, and a whole lot of people I know in Patrol and other departments dropped in to see how I was doing, including the head of Patrol, Martin; Al, the Mountain Operations Manager; and the head of the ski school (and head of the SnowHost program), Stuart.

One service SnowHosts provide is called a "ride along", where we go down in the Gondola to accompany injured guests. They couldn't find a SnowHost (we don't carry radios), so Stuart escorted me down. Karen arrived just as the got to the bottom. I was loaded into the car and trundled off to the hospital, a 15 min drive.

On arrival at the hospital at 3:15 PM, I was triaged immediately and put in an emergency bed. There were 5 other tib-fib fractures in emergency Friday, in addition to me. A doctor saw me after about 30 min, and I got X-Rays. The doc looked at them and told me I was looking at surgery, and that the on-call ortho doc had already been called. He showed up after another 30 minutes. He told me I had a "butterfly" fracture of the tibia, wherein a wedge shape piece of bone had broken out of the middle of the tibia. I also had a radial fracture of the fibula up near the knee that wasn't major and didn't need any specific treatment.

For my tibia, he said the only real option was to put a titanium rod down the middle of the bone to stabilize it. It potentially could be fixed by just letting the bones heal under a cast-like object, but that wasn't recommended for a number of reasons. Here's a video of the rod procedure.

He told me I was 2nd in line for surgery tonight. At 5:45 PM, I was admitted to my room. At 7:15 PM, the anesthesiologist came in to discuss procedure options. At 7:30 PM, I was wheeled into the OR. By 8:45 PM, I was in recovery and by 9:30 PM, I was back to my room.

I opted for a spinal anesthetic instead of a general, so was kind of awake for the procedure. Yes, the rod is hammered in. With a HAMMER. I heard the incisions, the hammering, the stapling, the suction, and a bunch of other fun stuff.

Coming out of recovery, I was numb from the waist down, and that slowly wore off over the next 7 hrs, until about 4 AM. They checked my vitals frequently (every 15 min for a few hours, then every half hour, then every hour).

I also got a room mate, a chap from Oakville who broke his ankle in a crash avoiding a skier at Lake Louise. He got 4 screws. He was 3rd in line, and joined me at 10 PM. We got to spend the night trading ski stories, for sleeping was a non-starter until almost 6 AM.

Once the spinal wore off, the concept of "pain management" reared its head. I tried percoset, but that didn't do anything. I got 10 mg of morphine at 6 AM, but by 8 AM, that hadn't achieved any change. So I was hooked up to a self administered morphine pump, given the warning that I had to be off the morphine and back on the percoset with pain managed before I could go home.

I spent Saturday spaced out on morphine, occasionally passing out sleeping while I had visitors. I had a solid 90 min nap mid afternoon which left me feeling much better -- for about 20 min. But it was clear I was spending Saturday night in the hospital, too. My roomie was discharged at lunch.

I thought I would get solid rest on Saturday night, but it was not to be. I had pain that was not pleasant and keeping me awake, I couldn't get comfortable, and I got nurse visits every 2-4 hrs. So I probably got 2 hrs sleep between 4 AM and 6 AM, and finally gave up trying to sleep at 6:30 AM.

I was discharged at 10:30 AM when Karen came to get me. And so for the next 2 weeks, my instructions from the doctor team are that I know only 4 rooms: the bedroom, the bathroom, the kitchen and the couch (which I didn't know was a room). This afternoon has been a struggle in figuring out how to do this 4 rooms thing, while taking a whole lot of percoset. So far I'm 50:50, with a whole whack of pain that isn't pleasant that the percoset doesn't seem to manage well.

Interestingly, I have no cast, nor am I likely to get one. I'm non-weight bearing for 6 weeks (that's May 30th), using either a wheelchair or crutches until then. I can't drive, since it's my right foot. My first follow up will be ~April 30.

Which is/was the day we were to head for Africa.

Which is now off. And we have no travel insurance for it (I never get that, figuring that when I'm committing to go, I'm committing to go). So we're trying to contact the safari company and re-schedule the safari to the fall.

I'm less worried about the flights. I paid for them by AmericanExpress, and I have trip cancellation insurance through them. But the safari company only took MasterCard, so that wasn't an option.

I'd call this a major screw up on my part, and a really unlucky break.

Saturday, 12 April 2014

April 12: Winter? Spring? Powder?

Perhaps it's the Heartworm/bleed/break virus, or the fact that internet in Canmore has been spotty this weekend, or some other goofy technical reason, but is not accessible to me for, like, the 4th time this season, so you get me here instead of there (and here isn't working very well, either).

Other commitments have kept me from skiing this week. I went tubing with my daughter Friday, and that was a riot, but the conditions at Norquay were very, very wet and spring-like. So when I got to Sunshine today, I had kind of low expectations for winter conditions, figuring that Sunshine was like Norquay.

I was wrong.

I worked in the parking lot this morning, and so only got up to the mountain at noon. And it was winter. The hill was only reporting ~2 cm overnight, but I found 5-10 cm of fluffy powder everywhere I went. In addition, it was sort of sunny and beautiful all day -- perfect for snow quality retention.

Frome the village; 11:45
I took a tour out today, and was able to take my guests in untracked powder with ease. We had a riot covering the mountain, and seeing stuff like this:
The Dive from Goat's Eye. 3:15 PM
It was a real mix today of powder on fluff, powder on crust, groomed crusties, powder on crusties, and everything in-betweem, showing that it got sunny and warm earlier this week.

After my tour, I got into the South Sides. Awesome. The upper Wildside entrance is a combination of powder and un-crusted moguls, but the lower section way over to the left near the boundary fence...

Looking down at the Tobacco Road entrance
My tracks, and a very few others
...was fantastic untracked 10+ cm on a supportive crust, which made for really fun riding.

I had low expectations for the day, when in fact it ws just a fantastic day of winter skiing.