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Friday, August 2, 2013

To Continue PT or Not Continue PT....?

That is the question.  But first,

The Battle: Part 3


So the PT came again and Bob, bless his soul, was cooperative and did all the exercises without complaint. Even though I could tell that he was in a lot of pain. So, dropping the nursing home bomb worked on Bob, at least for now. The therapist was only 15 minutes late and stayed 45 minutes, this time. Which is better than two hours late and staying 30 minutes as she did the first time. But not as good as the second time, when she was on time and stayed a full hour.... I hope this is not becoming a trend.

I do begin to wonder if we should even be continuing with the PT right now. It seems such a torture for Bob and that is mainly because of his foot. But the therapy was prescribed for post-Botox treatment of his neck and hamstring, you know, stretch those muscles out and try to get him a bit more range of motion. His neck is still very, very tight, though that hamstring seems a little more relaxed. And though he does complain that the neck massage and stretching "hurts", he is mostly complaining about that darn foot.

Yesterday, we went back to see the foot surgeon. We had a 9:25 a.m. appointment, and I tell you, I hate those morning appointments, because that means I have to get up at 5:00 a.m. and rush around like a madwoman to get us both ready for 8:30 a.m. transport. After all of that, the foot surgeon, of course, was running behind schedule. Once again, a tech came in and x-rayed his foot.

Finally, the doctor arrived and said the x-rays look "good", but then Bob piped up with "CUT! CUT!" and "OFF! OFF!" meaning he wanted that doctor to amputate his toes, right then and there. I was rather shocked by this outbreak, as Bob and I had discussed this appointment before hand, as we always do--mainly because I need to know exactly what he wants from the doctor before we go, as most doctors do not have the patience to listen to Bob while he tries to find the right words to express his desires. Well, we certainly had not talked about amputation! To me, that seemed a rather drastic solution to the problem. And I tell you, the doctor was pretty shocked by this too.

So the doctor squatted down by Bob's foot and pointed to each toe and asked him if it was that toe which hurt. Bob indicated that every toe hurt and he wanted them all cut off! Yikes. By now, I'm quite baffled because before hand, when Bob and I had discussed this at length, I was under the impression that the first three toes were "better" (Bob's word) and it was those two little toes which were the problem. So, I pipe up then and tell the doctor this, and Bob points an accusing finger at me and snarls, "NO! WRONG!"


The doctor seemed just as baffled as me, saying that the three big toes looked like they were healing well and stating that he was "sure" he could "straighten out" the two little toes with another surgery. This time, however, instead of just cutting the tendon, he would remove those "knuckles" and put pins in them.  Hearing this, Bob said, "NO! CUT! OFF!"

And the doctor said that he thought amputation was quite drastic, although, if the surgery did not work, he would consider it. But he really thought the surgery would be the least drastic measure here and should be tried first.

By then, Bob is nearly in tears. Heck, I'm nearly in tears. But I ask the doctor how soon we could have this surgery, because, really let's get it done as fast as we can. He asked when the pins were scheduled to be removed and I told him August 15. And he said, he could probably "take out the pins and do the second surgery at the same time".

So I ask the doctor if we can do the surgery at the hospital (where Bob gets financial aid) instead of the surgery center. And I mention that the anesthesiologist had said we should not have been at the surgery center, but at the hospital, as the surgery center has no emergency equipment etc. if there is a problem. But the doctor pooh-poohs this idea, telling me that he doesn't have "privileges" at the hospital and he would get "bumped" and have to do surgery "after 6:00 p.m." plus he doesn't like their facility and equipment and, he said, that since Bob had no trouble with the first surgery, there was no reason to think he would have trouble with the second as it is a less intensive operation....

So, we are looking at the second surgery around August 15th. And we'll have to pay another $250 up front. But I hope he doesn't have to go through all the pre-op testing again. I'm waiting for the scheduler person to call and set it all up.

But back to the PT question. Which is do we continue with it now? Or wait until after the second surgery?

But if we wait, will Bob completely lose any effect from the Botox?

And if we continue with it, will the insurance pay for more therapy AFTER the surgery?

So far, I have backed the PT down to two times/per week instead of three. I figure this way, 20 visits should take us clean through the end of September.... As I really think Bob needs to start moving, he is getting so weak, and most days doesn't even want to get out of bed, so at least with the therapist coming twice weekly, it will be better than nothing....and I don't understand why stretching his neck and leg should bother his toes, it's not like she's making him stand up or anything. 

But still, I do hate to torture him... and even though he didn't complain at the last session, I could tell he was in a lot of pain and not very happy.

She's scheduled to come tomorrow. Right now, I'm just taking it day by day. See how it goes. But believe me, this question is on my mind...


Anonymous said...

Does Bob's neurologist talked to you and Bob about the possible of ITB (Baclofen)Pump? In case you were wondering here's the website:

Anonymous said...

At first I was going to suggest just upper body PT, but you stated Bob appears to have lots of pain in his feet when that occurs. If he experiences extensive pain while doing his PT, then I believe it needs to cease or be adjusted so the pain doesn't take place. Talk with Bob, and see how serious the pain really is.

If Bob's toes were to be amputated, would that really alleviate the pain he is experiencing??????

Instead of using the NH threat for not doing PT, perhaps it would be better to use that threat for a daily routine of getting out of bed and into his wheel chair, followed by what ever other daily items he can or should be doing.

Lots of hugs and prayers for both of you. Dan

Theresa Loder said...

Hi Diane
I am sure you have heard this before but they always ask Rick what his pain level is from 1 to 10

Could that help...sometimes Rick would say 13...he was in a lot of pain...

Poor Bob ...many prayers for both of you...hugs

Take care