Wednesday, August 18, 2010

Neurapraxia & Paresis, or Why I Still Can't Talk

Remember back to before I found Gumball, and I had to have neck surgery, and I was left horrifically disfigured (according to Rosie Perez), and then the doctor got concerned about my persistent hoarseness, and referred me to the ENT?

Well, I finally got the appointment with the ENT, and boy, did I have fun! A week before my appt, they sent me an eight-page history form to fill out, as if I was signing up to receive a lifetime of ENT care from this dude - I absolutely cannot believe the unbelievable lengths they went to to ask me all sorts of absolutely, positively, irrelevant questions, for someone being referred for a post-op complication. But I filled it out.

So then I get there, and they want my picture for their electronic medical record (this, right after they photocopied my driver's license to insure I wasn't committing insurance fraud). So I refused - which I'm guessing from the look on the clerk's face NO ONE has ever done before - but could she not see?: I am horrifically disfigured - just ask Rosie Perez!

So, after waiting 30 more minutes, they finally called me back, and demanded that I step on the scale - again, totally irrelevant to the reason of my visit. Then the tech starts going through the 8-page history with me, because poor girl has to enter it into the electronic medical record (EMR), and she doesn't understand any of the big words I used! So sorry, little untrained technician, that I called my hernia repair a "herniorrhapy", etc, etc - because this part took another 30 minutes. (And the ENT really didn't need to know about my hernia, or my hemorrhoids, or my hysterectomy. Good grief.)

So tech girl finally finishes, and tells me not to worry, because my surgeon refers "tons" of people to this ENT for this very problem. HOLD THE PHONE - he told me I was only the 3rd one in all his years of having performed the surgery to ever develop the problem in the first place, and now there are "tons"?!?!
So I gave her my MOST sarcastic voice, and said, "My, THAT'S reassuring."

Then the ENT arrives (with tech girl in tow), so I took that opportunity to ask about the tons of referrals he's allegedly receiving from my surgeon for this "unusual complication". And he repeated the stats from MY surgeon - that I was only one of three. I bet tech girl invites me to her next Christmas Party!

Then he reaches behind himself and grabs a brown bottle with a long nozzle on it, and rolls closer to me and starts to aim the bottle at me, when I pipe up and say, "You DO realize I'm allergic to that". For I knew it was lidocaine, which I am very much allergic to -so much that I had listed it as #1 of my allergies on page 6 of the 8-page history form. So he leans around me to where tech girl is scrolling through my EMR searching for the allergy portion, which she displays, and he stares at it like it was some lie I'd pulled out of my ass just to screw up his day. Then he started to interrogate me in this patronizing voice, trying to determine whether in fact I was truly allergic to lidocaine, or maybe just didn't like the taste of it, or what, exactly? Seriously - what do I gain by being allergic to the most commonly used topical anesthetic? But I gave all the correct answers (whew!), and he put the bottle down, and I told him that my other doctors dealt with this by using marcaine or carbocaine, usually.  He says he doesn't have anything except lidocaine.

So he whips out the laryngoscope (basically, just a much shorter version of a colonoscope), and tells me that when he was a resident, he had to perform this procedure on himself numerous times without anesthesia, and it really isn't that bad.

And he passes me a hand mirror, and shows me how to sit so that I can watch the whole thing on TV. Woo-hoo!

And he starts passing the scope up my nose and down my throat, and of course I'm coughing and gagging and tears are streaming out of my left eye, and he is assuring me that all this is normal, and giving me little instructions like "cough," "swallow," etc - in between all my coughing and gagging. And all the time, he is narrating this like it's the "It's a Small World After All" Ride at Disneyworld. "and here on the left you see your normal left vocal cord," etc.  And all the while he is calling out stuff for tech girl to enter into the EMR - sounded like a few big words, too - so no telling what really went in there.

But alas, while I have no vocal cord polyps or nodules, my right vocal cord is about 99% paralyzed. Not 100% - he saw a minute amount of movement. So the technical term for what I have is (extreme) right vocal cord paresis (weakness).

And this paresis is due to intra-operative damage to the right recurrent laryngeal nerve, probably during some cauterization of some bleeding during the surgery.

And then, having given the tour and determined the source of my problems, he removes the scope. And I choked out the words "you DO know I'm a physician, don't you?" Well - seems like in all those 8 pages of history, THAT never came up. So he says "No", and then asks what type of physician I am, and then asks if I have ever seen a laryngoscopy before (yes).

So then he proceeded to outline the 2 possible surgical repairs of this condition (neither of which would be considered until after the normal healing time has expired), and neither of which sounds like fun. In one, I have to go into the hospital for outpatient surgery, and they would pass the endotracheal tube down my throat, and I guess a laryngoscope, and visualize the cords, and then he would inject Restylane (the collagen-like substance that women (mostly) get injected into the wrinkles on their faces) into my poor paretic right vocal cord, thus plumping it up and allowing it to meet the left vocal cord in the midline, so that normal sounds can come out of my throat. There was no discussion of complications, or how often I would have to have this done (I know women who use Restylane have to keep getting the injections in order to keep the look they achieve with it). - no discussion, because it isn't time yet!

Option number 2 is also outpatient surgery - and had a really long name, but basically it involves going into my neck surgically from the front (he thinks he could use my horrific Rosie Perez scar, though, instead of making another horrific scar on my neck) and then inserting a piece of Gortex right next to my poor paretic right vocal cord, thus pushing it over to the midline. Permanently, I guess. Again, no discussion at this time, because I still have lots of healing time on the clock!

The technical term for my condition, in the ENT's professional opinion, is "neurapraxia," "an injury to a nerve that interrupts conduction causing temporary paralysis but not degeneration and that is followed by a complete and rapid recovery" ("rapid" being an extremely relative term). The recurrent laryngeal nerve, according to the ENT, regenerates at a maximum of 1 mm per day, and the damage is approximately 70-80 mm from my vocal cord, so it could be as few as 70 days (from the surgery) until it heals, or it could actually be up to twice as long as that, if I am a slow nerve regenerator. 70 days would be on Sept 2; but that is the best chance scenario. 160 days is December 1.  He wants to see me back for a repeat laryngoscopy (without anesthesia!) on September 13. But here's the deal, if I am still hoarse (even if I am somewhat better) on September 13, he will do the scope again (oh joy) and then tell me that I still have a bunch of healing time left - and set another re-scope date. So I am going to watch this thing, and if I am not 100% back to normal by September 13, I am going to reschedule the scope date again, and again, and again, until it is past December 1, and then he can take another look.

It was really a pretty traumatic procedure for me, and I'm sure he has bills to pay and all, but I cannot see what I personally have to gain from being scoped until the time is up. Plus it ain't free, even though I have insurance! And I will ask to forgo the mm by mm detail of my throat's anatomical structure on the next scope, which should make the procedure last about 25% of the total time it did this time.

Sunday, August 15, 2010

Gumball is Home

We ran ads, put up flyers, left flyers at all the vet offices in the area, and did a few more things, and no one has stepped forward to claim this little guy. Which just dumbfounds me - I wish he could just tell me where he came from, and what he's been through. He is SUCH an angel.

As small as he is, he is able to jump up on most of the furniture - and acts like he has always been a furniture-sitting kind of dog. Certainly, at the very least, he was a well-cared for, inside dog.

After 2 weeks with no responses, I took him to Bailey's regular vet, who did a thorough exam, and agreed with the vet from the animal hospital - he had been well-cared for, lots of money had been spent on his surgeries, and he is in excellent health, other than being underweight.

She (Bailey's vet) estimated, based on his current body weight, that he had been on the run for about 4 months when I rescued him, because he was just over 25% below his normal body weight. And therefore, he needs to gain 4 pounds. Which I could easily gain in one day, but not so with poor Gumball.

She wants to start him on Rimadyl because of his severe arthritis (you can hear the bone-on-bone grinding noise from one of his hind legs/hips when he walks, and his gait just in general is "arthritic") - but Rimadyl is more expensive than I can afford (even though she tried to break it down for me, and told me it was only 46 cents a day). That didn't really change anything because I can do math, and 46 cents a day is still basically $170/year. So I did a little research when I got home, and learned that while dogs canNOT take ibuprofen, they CAN take enteric-coated aspirin, which is also an anti-inflammatory. And they can also take glucosamine chondroitin - and so I started him on both of these, for way less than 46 cents/day. Just started them yesterday, so I don't see any changes yet.

We went straight from the vet to PetSmart, which was having a going-out-of-business sale, and I let him try out a few beds, and he picked his favorite, and so I bought 2; 1 for home, and 1 for work. And we also bought a nice sturdy set of pet stairs, so that he can get up on my bed (and down) without being lifted (and without jumping off the bed, which can't be good for his arthritis). The little guy really doesn't like to be lifted - I'm sure it hurts his arthritis. But he wants to be right by my side.

At home he is fond of claiming Bailey's giant bed - which of course peeves poor Bailey. But Gumball only does this during the day - at night he sleeps in his own new bed.

We get up about every 3 to 4 hours during the night for potty breaks, because he's a small dog, and also an old dog, and just can't comfortably make it through the night without going. He WAS holding it all night when he was sleeping in the crate, but after the 1st week (probably as he was gaining strength) he let me know that he had NO intentions of spending the night in that crate. And since I have to get up myself every 3-4 hours during the night, sadly, I just now have added in throwing on shoes and  taking him downstairs and out into the yard. And then back upstairs again. He is actually walking all this way himself now - I rarely need to carry him, but all this extra activity for ME at night is making it very hard for me to fall back to sleep, so I am basically tired and sleepy all the time.

I see improvements in him everyday, and after the 1st 2 weeks, he has become a regular eating machine.

After the vet told me he needed to gain 4 pounds, I started to feed him much more often, so he's eating what seems like a huge amount of food, with real gravy for even more calories, about every 3 hours. And it seems like the more I feed him, the more he wants - it's gotten to where every time I take him out he comes back in and starts doing the little "feed me" dance in the kitchen, hopping around the spot where his bowl goes while I fix his special food. Another thing that peeves Bailey greatly. (the special food, and the frequent feedings)

The basic routine is eat (which takes almost an hour), then sleep for 3-4 hours, then potty, then eat, etc., etc.

But when we get up in the middle of the night for potty breaks, I am not giving in to his demands for a meal after every potty break - although he is certainly asking for one. I'm going to run him over to the vet in a couple of weeks to check his weight - I sure hope he's gaining. I thought he was BEFORE I took him to my vet, because he was so much more active, and his eyes were brighter, he was more alert, and he looked more filled out than when I had rescued him. But at the vet visit, he had actually LOST almost a whole pound from what he weighed the day I picked him up - do you remember me half-joking awhile back that when they weighed him at the animal hospital he was so flea-infested that I was sure 1 pound of his body weight that day was fleas? 

He sort of reminds me of the "Doomsday Machine" from the classic Star Trek episode of the same name - which was basically just a giant maw that ate everything in its path                                                                                                                                                                          

and even tried to eat the Enterprise!

The only difference (well, maybe not the only one) between Gumball and the Doomsday Machine is that it takes Gumball almost an hour to eat each meal, since he doesn't have any teeth and no lower jaw. He has to work the food into the back of his mouth and down his throat with his tongue, and he makes a big mess, and he may take a long time, but he sure is determined, and he loves eating!

The day before we went to the vet, I had given Bailey a big marrow bone, and Gumball stole it. The vet said that Gumball remembers eating solid food and chewing bones, and that it is OK to let him have the bones (even though he can't chew them), so now he has them, and he licks and licks them, and just has a big old time. And as long as it makes him happy, I'm OK with it.

Of course, Bailey is not pleased with all the bone-stealing, even though I immediately give him another one. Bailey, of course, devours them in a matter of minutes, and I'm sure he doesn't understand how Gumball can just casually spend days savoring one. So Bailey has gotten in the habit of waiting until Gumball gets out of his bed, and then Bailey "sneaks" over and steals the bone. And I can tell every time he's done it, because he sort of ducks his head and tries to hide the fact that he has a huge, re-stolen bone in his mouth.

This is Gumball's favorite spot at the shop - in his bed, staring at me. He spends most of the day there (with frequent meal and potty breaks), but if I have to be up and wandering around, he follows me like a baby duckling, And if the store is full of customers, he gets confused by all the legs, and will start running around trying to find my legs.       

Yesterday was a very busy day at the shop, and so Gumball was excited, and running around trying to keep track of me.  I even left for an hour to run errands and pick up lunch, and when I got back, Gumball wasn't in his bed, and my employee told me he had wandered through the store in a continuous loop the whole time I was gone, looking for me.

I had picked up Chic-Fil-A for lunch, and I went into the backroom to fix Gumball his lunch, so he could be eating while we ate out front, and before I even put his bowl down on the floor, my loyal employee had started hand feeding her chicken nuggets to Gumball - she was breaking them in half, and dropping them in his mouth like a baby bird, and he was in 7th heaven. So then he completely refused to eat his own food, and when her nuggets were gone, he came over to me and started begging for my chicken. Which, naturally, I gave him.

So now we have created a tablefood-begging monster.

And this is my little sweetie sleeping on the job.

After he finishes his meals, he usually sleeps for 3 or 4 hours if we are at home, where there are no interruptions. At the shop, if we are having a slow day he'll sleep that long, and then wake up, go potty, and demand more food. But if a customer comes in, he wakes up, and usually goes over to greet them.

So, it is now too late to make a long story short. But Gumball seems to be thriving, and seems happy, and is here to stay.And Bailey is still jealous and pouty, but is doing much better.

And I need to take this opportunity to give a huge shout-out to Jan from Heartworks. She is a very special lady, and a very talented graphic artist, and she did something incredibly nice for me, and so thoughtful. She'll never understand how touched I was. You guys take a few minutes and check out her beautiful work - and trust me, she can do incredible custom orders!

I apologize for the length of this post, and I feel pretty certain it rambled, and I repeated stuff. I had a really rough night; didn't sleep much at all because of a headache that wouldn't respond to any medications (all of which should have made me sleep) - so between the headache & not sleeping, I can't concentrate well today. I have tried to reread this post for editing purposes, and I can't even concentrate enought to do that - sorry!

Sunday, August 8, 2010

A finished project

I finally, finally finished this kumihimo necklace - it is gorgeous, and it was a lot of fun to make, but I am NOT a knitter (not that there was any knitting involved) - it's just that I have always been fascinated with this "eyelash" yarn, so I used 3 different colors of it in this necklace (which contains between 18-20 different fibers altogether) - and I quickly learned that after every single half kumihimo stitch, I had to take the beader's awl and tease out all the eyelashes, or else they ended up woven into the inside of the rope - which pretty much defeated the purpose. So I would do a half stitch, then spend 15 minutes teasing out fibers, and then do another half stitch, etc., etc - After about 2 hours, I would toss the thing down, and would take me a week or 2 to get up the courage to start it again.

Sorry - everything looks yellowish in this picture with the mannequin. She is too large to fit in my photo tent, and the light in the room where she is is terrible (or maybe she has jaundice.....)

This rope is the perfect way to show off this huge lampwork bead that I have owned for almost 3 years, and had NO idea how to use - the rope is thick enough to support it while keeping it from sliding around, yet very lightweight - everything just worked out perfectly in this design.

And sometime over the next couple of days I will try to catch everyone up on Gumball, who is doing well!