Tuesday, March 18, 2014

timing is everything

After two lots of breast surgery and then 4 whole days of rest, it was time to fix the foot!

After the pain block [administered during foot surgery] wore off, I did find myself wondering "Oh, my God, what have I done to myself? If I had known it would hurt this much..."
But, anyone who knows what they are on about will tell us that bone pain is pretty much the worst type of pain. I've no way to compare the heel pain to the pain of childbirth. I would like to think I have a rather good pain threshold, but part of enduring pain is knowing that it will pass. After 24 hours the pain became tolerable, but in future cases of "elective" surgery I will probably make a point of asking how long it will be before the pain becomes manageable. Just so I can be psychologically prepared, you know?

Not long after I was returned to a ward, TO came to visit me with a brand new pair of crutches. [Not Prince Henry's vintage and, in fact, purchased by TO from a chemist shop.] Price approx $50.

Why do I have a picture here of barre exercises?
The answer is because I had sort of pictured the crutches
helping me walk gracefully...

Once I was home, the only way to get upstairs was backwards, on my BTM. Not only have I not swum a lap for ten years [hence the bingo flaps], but also have to haul more weight up the stairs than I should be carrying – it's almost as if chocolate is designed to come back and bite us in the bum.

On my first day home alone, TO headed off to work. At some point I tried hobbling on crutches to the powder room, only to lose my balance and flip A over T.
The surgeon later suggested, by phone, the enormous cracking sound I heard was probably the sound of the plaster cracking a little. I did not discuss with him the other sound I heard when I fell –a word I must confess I have used once or twice before.

That night, TO decided that because of the breast surgery [and the consequences of my own innate laziness] my arms were not strong enough for crutches and we should hire a knee cruzer.

4 Minutes into this clip you can see this thing has a great turning circle.

The cruzer TO ended up hiring – apparently the only short-ass option available – has a turning circle of 5 miles. Negotiating some corners in the house required either a 20 point turn or that I simply stand on one leg while picking up the knee rest and turning the entire scooter by hand.
For all its faults, my relatively crappy knee cruiser was a great success. Every single and/or married male from 5 to 95 that I knew [and some I didn't]  "had a go" at riding it. Each and every one of them enjoyed talking about a better way to design it for steering or manoeuvrability.
Just the same, for the price of delivery, return, and 4 weeks' rent, it might have been better value to simply buy one.

After a few weeks, it was time to remove the plaster and 15 metal staples from my heel.

A Moon Boot - Costs the Earth

Mr B, the bone man who fixed my foot, seems not to be in the business of supplying moon boots or ancillary equipment himself – but some extremely enterprising "company" keeps a woman on hand in his rooms to personally "fit" boots and stuff to people's heels as needed.
As the staples were removed, the wound dressed and then the boot fitted in one smooth sequence, I found myself forking over a 25% share of our little house in Franger before I had a clue what I was doing.

A quick search of the 'net now shows that I was well and truly robbed – the words "one time use only" stitched onto the boot seem a tad extreme to me. Even new it would be easy to find a boot much cheaper than the one I bought.

I shan't complain too much. Mr B has accepted medicare and private health care contributions as payment in full for the whole bang lot [except for the boot and compression stockings]. Nonetheless, I have now learned that some advance planning and questions about spending on complementary products before surgery might be a good idea.

Once I was in the moon boot, the crutches were actually handy as they helped me control just how much pressure I was putting on my foot at any point in time. I really only needed the scooter upstairs for the last week because TO did not want to hear me fiddling with Velcro straps in the middle of the night when I needed to go potty.

The surgical wound on my heel has been slow to heal. Here's a picture that will give you an idea of the size and location of the wound:

The timing of this surgery is an example of a case where TO did not put 2 and 2 together properly – radiation therapy does make the body take longer to repair.
The infection was only kept under control by the miracle of silver sulfadiazine dressings.

The exciting news is that I have now ditched the moon boot, and have a lift inside one of my proper shoes. I can drive! This will save  me what has been an average of $27 -$28 per day in taxi fares to and from radiation therapy. Phew.

The public vs private health system question is a question I'm not sure there is a clear answer to. With respect to a Haglund's procedure, what I can be reasonably confident about is that it would never be urgent enough to actually get done under a public system.

So, my private health insurance covered the cost of 2 nights in hospital.
It also contributed to the cost of consultations, surgery, anaesthetic, etc.

I've had to wear the cost of the crutches, the cruzer and the boot. TO's timing of the surgery has cost quite a bit of her energy, and a lot of dough on taxi-fares. In about 6 months' time I'll be looking for treatment to fix my right shoulder which has not been quite the same since my big powder room fall.
On the other hand, TO's connections have saved me tons of dough on "gap" payments to surgeons and anaesthetists.

I've learned a few lessons from this exercise - though hopefully I won't need to use them in a hurry - ask up front what I'll need, when I'll need it, and make sure I will have time to shop around.

For so-called "elective" procedures, private health insurance is a must, but on its own not necessarily sufficient to keep us covered. As I shan't be putting up with the burning, searing pain in my leg for the next 20 years the out of pocket expenses were worth it - but probably only because we could actually afford it.

Sorry peeps - have been a tad seedy, grumpy, busy etc. TY for sticking with me. :)

Friday, March 14, 2014

the sky is not falling but my bank balance is


THE STORY SO FAR: because my heel was sore, I had a mammogram [as you do]. 2 different lots of breast cancer were found very, very, very early. What follows is about the heel, health insurance and the costs of treatments generally.


After a particularly crappy 3 months TO had been looking forward to a few months' working only 30 hours a fortnight. Suddenly, on 27 December she came home to learn that not only had I had a mammogram without telling her, the GP had rung less than an hour after I got home from the mammogram, flapping about making an appointment to see a breast surgeon.

What TO then had to deal with for too long [i.e. over the holiday period] was too much general knowledge but not enough specific information about ME or MY cancer.
What she really needed was to spill her guts /vent about this [plus a whole heap of other ongoing stresses] to someone neutral like a counsellor but, holiday periods being what they are, one could not be found.

The "too much knowledge" bit begins with a wee snippet about lymph systems. Think "lymph system" think "crap catcher".

As an analogy, let's say we have lymph nodes [gully traps] in our armpits [amongst other places]. Once toxic stuff [like lead paint] hits the gully trap, it all heads straight for a natural waterway somewhere. [Eat more fish…. it's healthy!]

The lymph system to which the left breast connects directly is a bigger system – if one must find breast cancer one hopes to catch it early, and in the right breast. Of course, if someone does find themselves with cancer in the left breast [as I did], it is not a good idea to have a partner who catastrophises].

A rather long and tedious journey down the cancer treatment path lay ahead of us both. It's nice to have a partner with whom one can discuss things, or to whom one can whinge – but two partners discussing things does not necessarily involve solutions or miracles, it's often just venting and should not be taken to be an obligation or expectation.

TO, when it comes to other people's medical issues, does not know how to ditch the God Complex. If someone is unwell she feels personally responsible for the illness, and for finding solutions. Late last year she coached one of her old school mates through the death of a 41 year old son. TO had been telling him for ages to do something about his reflux, but unfortunately, R did not do anything until it was way too late. This was very draining and distressing for all concerned, and just one of the things TO was dealing with.

Aunty has had a series of medical dramas. She has had a series of hospitalisations to go along with the dramas. Although TO has often been right about what to do next, even when specialists and experts are scratching their heads TO cannot let go of the notion that she should know what to do. It is only because I know her that I won't accuse her of arrogance but there are times I'm tempted to beat her repeatedly on the head with a heavy pan.

TO's motto, I think, might be "bite off more than you can chew then chew like crazy". The more tired she gets, the faster and more frantic she becomes about the things she "has" to do. If her car was running low on petrol she would speed up, hoping to get "there" before she runs out of fuel.

TO "knew" that if I did not get my foot fixed now I never would. She pushed me to get it done straight away so I might be well enough for at least one week of her holidays in April. So, there we were at the starting line, the gun went off and within 2 seconds TO was way in front while I slowly brought up the rear.

Over Christmas we made a three day dash to Jindera to see TO's Mum, then came back home.

Briefly, next jobs were
-         do lots of running around and stuff for Aunty
-         visit breast surgeon of choice
-         go to clayton for stereotactic biopsies [and insertion of titanium clips]
-         visit surgeon for path results from biopsies
-         decide what sort of breast surgery would be appropriate
-         x-ray guided hook wire attachment to titanium clips
-         the breast surgery
-         the path results from the breast surgery
-         first visit to orthopaedic surgeon about the foot
-         the oops-we-need-an-extra-bit-chopped-out discussion about more breast surgery
-         the extra breast surgery
-         the foot surgery
-         the path results for the extra breast surgery

and so on, etcetera and so forth ad nauseum and infinitum.

Through the latter stages of this, there was a lot of the daily grind to be taken care of [by the only household member who was mobile and did not need to keep their leg elevated.]

TO got tired.


I'm glad TO was with me for my first appointment with the breast surgeon. I thought I was calm, accepting and perfectly rational about the whole business, but did not hear a word the surgeon said beyond "bilateral mastectomy". To be honest, even if I had heard what she was saying, I would not have had any idea what it meant.

As I tried to recall the content of the discussion, a loop was playing in my mind of Whoopi Goldberg trying to catch the lyrics of Jumpin Jack Flash, saying "Mick, Mick, Mick… speak English!"

While TO did all the "two legs good, one leg useless" household stuff with no one but a floor manager to help, what else was there for me to do but stare catatonically at a pc screen trying to discern the deeper and more profound meanings of breast cancer terminology?
No matter how calm or accepting one is, one still hopes to know what is happening "tomorrow". How would all of this affect my self-image? Would breast conservation surgery and breast reconstruction be an issue? To be honest, if I had money to waste on vanity, I would rather use it to remove acne scars. But I was not let off the thinking hook - types of surgery and so forth were still an issue because everything has side effects.

One thing I found most intriguing is that
  • the original imaging report from my mammogram said lesion 1 was "highly suspicious for high grade DCIS" [i.e. I should panic]
  • pathology results from my first lot of biopsies said lesion 1 was only ADH [effectively bugger all]
  • second lot of pathology reports after my first lot of surgery said lesion 1 was invasive cancer…

Forget lesion two – can you see a pattern emerging here with lesion 1? This pathology stuff is not quite an exact science. I guess what "they" find depends to some extent on what bits they take and then examine. We are talking about margins as small as 2 mm, here.

How long does it take one rogue cancer cell to grow enough before it is visible on a mammogram? The answer to this and a million other questions seems to be "it varies from one person to another…"


I did discover before surgery that there are extra comfy undergarments available, but after a week and half of searching still had no idea where to find them. I was given one – free of charge - the day after surgery. We were in the middle of a disgusting heatwave, and after a few hours on the phone I managed to track down some more. It cost me $136.00 for the last two pair in my size available through Myer in Victoria. I will never say horrible things about Myer again.

Finally stumbled on the web address www.bcna.org.au and requested a specific booklet from a series. Received the entire kit [which is bigger than the tax act] full of booklets, brochures and DVDs. All the stuff I'd been trying to work out was covered in the kit and could have saved me a lot of searching.
The stuff in the kit was logical, detailed enough without being too detailed, and included a 50% discount card for those undergarments I had just spent my life savings on. Sometimes, my timing sucks.


Naturally, a lot of questions remain.

How does private health insurance stack up against none, or against a health care card?
Where should we go for more info or what other things should we consider before surgery [whether breast surgery or heel surgery]?
How much have I spent so far, and could I have saved some of this expense had I been better informed sooner?
Just how much has the great promise of Gough's original medibank system been eroded?

and more…

Tuesday, March 11, 2014

haglund's deformity

Haglund's deformity sounds like a good name for a soft porn movie, don't you think? Especially in light of the fact that Haglund's deformity is a bone deformity, sometimes known as "pump bump"!

No. This is not my own hairy leg.
I am blonde.

Title aside, this little operation story is far more interesting than one of Uncle Arthur's slide nights because, operation story or not, it's about ME. [If that doesn't whet your appetite for more detail, nothing will.]

Reader, I cannot tell a lie. For several years I have been … well, observing is the word I would use but TO prefers to call it complaining… that I can't walk/run/move any faster because my foot hurts. My heel has been killing me.

For the most part I kept trying to ignore it, even though it grew progressively worse. [No, not TO's nagging - the pain. Please concentrate!] 
At one point [during a brief-lived "scabby" phase] I took my heel bump to a bulk bill GP.

"Eeece shoo," was his diagnosis. "Wear better shoo", was his prescription. I spoke about the burning searing pain that sometimes woke me at night. "Eeece shoo", he repeated, with no emotion but with a great deal of conviction.

I started wearing sensible shoes decades before I heard lesbians referred to as "women who wear sensible shoes", but I guess the point would have been lost on him. How he could tell me my sensible shoes were not sensible shoes is beyond me – especially when he sounded like he came from a country where, until recently, any shoe that was within coee of the right size was worth a cuppla months' food on the black market.

My heel problem began, I think, long ago when I decided to learn how to tap dance. Just once I managed a slap up from one foot while skipping gaily down Burke Rd Camberwell and on that single occasion did something ouchy to my heel. So endeth both my brilliant career as a foot percussionist, and my love affair with Brazilian boots.
If anyone says I gave up tap dancing because I kept falling in the sink, they lie.

For several years TO has been pushing me to see an orthopaedic surgeon about my heel. If she is winding down her hours and retiring by the end of 2014, we'd best make hay etc before "our time-share"* expires.

Off I goes to organise imaging of my "pump bump". This was my Christmas present to TO and Aunty – once we worked out what the problem is – other than "shoo" – there would be no more nagging/ nor even speaking of the heel again.

My regular GP [$36 gap payment] referred me to a private imaging place that bulk bills for Health Care Card holders [IFF the item is medicare rebateable**]. I thought if I was going to get images of my heel bump I might as well have a mammogram at the same time [having absolutely not a clue how long it has been since my last one.]

"Make sure you get an appointment for a day Dr CH is the radiologist", said my GP and I booked my appointment accordingly.

As if being bulk-billed wasn't enough, this private imaging mob have a new you-beaut mammo machine that did NOT leave me feeling like my threepenny bits had been run over by a road train – only by a Vespa which as many of you might appreciate was way more cool!

"Please wait here", says the radiographer with her mouth, while letting me know telepathically that Dr CH the radiologist is a control freak.
The radiographer came back a few minutes later and said more images were required. I was chuffed – nothing bugs me more than dressing and undressing and dressing and so on. Let's just do the whole bang lot in one go.
I didn't even have to change before heading into another room for ultrasound.
The radiographer made me feel better when she assured me what I saw on the screen was not twins, but did ask me to wait as Dr CH liked to double checked the ultrasounds.

"What about my heel?" asked I, just before leaving. "Oh, all right then" Dr CH might have thought to himself, and gave my request about 2 minutes' attention.

Now, dear reader, I must acknowledge that I now know what I did not know until quite recently – 1 in 8 women who live to 85 will get breast cancer. It's unbelievably common. [No, I am neither 85 nor common – but traces of breast cancer were found].
Breast cancer is less common in men. I'm sure there is someone in Australia who really does give a shit about breast cancer in men but I have not yet been able to find out who.

If any of you have NOT yet learned the hard way what I have recently learned the hard way, I might be able to offer some tips. But first, I have one more confession to make: I'm an idiot.
Every neurone in my brain said "You've got enough on your plate, ignore the heel for now, don't be so bloody stupid" but the part of me that compromises [i.e. gives in 'cos it's easier than arguing] gave in.

Apologies everyone - I was so concerned with not making a big deal out of having breast cancer that I forgot at first to make it clear whether or not I do have cancer and then even when I tried to fix it did not make it clear that the cancer was caught very, very, very early - all because I had a sore heel.
The link between the cancer and the heel continues if you have not already become sick of wondering what on earth I'm on about.

*The time-share = the private hospital where TO works, where TO knows others and is known, and where we all seem to spend an inordinate amount of time getting a lot of medical attention.

** Whether or not something is rebateable by medicare is a bit of a mystery at times. One might just as easily turn base metal into gold, or get a free cup of coffee from Gina Rinehart as work out the medicare system. Maybe Tony will simplify things and just scrap it when he flogs off Medibank Private. It's a thought.