Stitches out

Yesterday all the stitches were removed - not exactly a painless process - but a real milestone. Now I use band-aids to protect my toes instead of heavy bandages which means i can now wear regular shoes instead of The surgical shoes i've been in for the last couple of weeks. I can also shower now and within a couple of day i'll be able to really get my feet wet - I.E. swimming, surfing, hot tubbing -- many things that I've been prevented from doing for that last couple of years because of the open wounds on my feet.

When I was in the hospital, just after I woke up, I had a number of weird dreams about swimming and river-rafting. Not white-water rafting, just floating down the river. They were so vivid that one of the first times I remember using my iPad (with my badly atrophied fingers) was to try to look up river rafting companies on the American River. I've never understood what was behind those memories and images but they were incredibly powerful and remain so today. Now that I can actually get in the water,  I'm pretty excited.

The final surgery

Last Friday marked an unexpected milestone on the road to recovery. It was a long awaited surgery to remove a toe from each of my feet. Both these toes were badly damaged by gangrene and after the black caps fell off they left open wounds and exposed bone on the end of each toe. After many weeks of waiting the wounds wouldn’t heal and continued to bleed regularly. Closing these wounds would also allow me to  stop taking the heavy doses of antibiotics that I’ve been on since leaving the hospital over a year ago.

The surgery went as planned – in fact it really went better than planned because after the surgery the pain was much less than expected. The unexpected part was the results of testing the amputated toes – we had expected to find infected tissue all though out the amputated tissue. Instead we found infection only in the exposed bone, not in the rest of the toes as a number of MRIs had previously identified. This is fantastic news as it pretty much confirms that all the infection in my is now gone and no additional surgeries are planned.

We had expected to find the infection throughout the toes and were going to “watch and wait” as I reduced and ultimately stopped the antibiotics. Now with the confirmation that the infection is really gone (and this is pretty strong confirmation) I can get back to healing without fear of more surgery and amputations.  

Data Coaching at Thunderhill Raceway Park

Izzy gets branded

I finally returned to track events last weekend. Not as a driver but as a coach. I been coaching drivers "in-car" for 5+ years but this was my first time coaching from a classroom with nothing but a lap-top. I've used a Traqmate system in my car to for many years to record and analyze performance data, but this weekend we used the SOLO/RaceStudio systems from AIM. It's a powerful system offering many more ways to analyze data that the Traqmate software. I'll be using it from now on.

My office for the weekend

Data-coaching works best for drivers who are already smooth and consistent. Novice drivers still benefit most from in-car coaching to get the basic and intermediate skills. However once a driver can reliably lap within a second or so they are ready to start using data for performance analysis. By using a reference lap as a target it is easy show areas for improvement. I set the reference lap in Kathy's totally stock 328ci. While the time was slower then the M3s and Corvettes driven by our students there are still a bunch of information to be gleaned from my lap.

Students getting ready

Right off the bat its easy to see the every student slows down too much for most corners and they slow in the wrong places. By showing that a totally stock 200k mile street car can go faster in the slow sections students can immediately gain speed all around the track. Then we focused on where the braking takes place. In many places students slow down too early and have to wait to get back on the throttle. We were able to show that by slowing less (often starting braking at the same point but carrying speed deeper into the corner) they were able to gain more speed Another area of focus is to ensure they are on the gas as early as possible as they enter long straights. Data shows when drivers hesitate applying full throttle in that situation it costs 3-4 mph for the whole length of the straight which translates to nearly a full second of lost time. We were able to show the slowing earlier, getting on the gas earlier yields real results.

Analysis - Note the track map, that is Thunderhill's new 5 mile layout -
It's awesome, now that Miller is gone it's my favorite track

It's quite remarkable how clearly these systems illustrate the impact of small mistakes and provide clear methods to address them. I really enjoyed coaching and each of my students gained at least 5 seconds per lap on track that they had each driven 10+ times.

I rode with both my students a couple of times (One drove an E92 M3 on Hoosier R6s, the other a Z51 Corvette on Pilot Sport 2s - both very powerful and fast cars) and felt pretty good during the sessions, but afterwards I paid the price for the physical exertion necessary to hang on in a car regularly pulling 1.4G in the corners. Wearing helmet really worked the neck muscles. I used to work my neck muscles regularly with a 10lb plate duct-taped to the top of an old helmet. I think I need to restart that if I want to do this again.

Monday morning was really tough, I was tired, sore and basically worn out. It took all I had to get out of bed and go to work. Even then I was tired throughout the day. I'd like to keep doing these events -- but I have to figure out how to feel stronger during and afterwards. This weekend was a true milestone; I feared that I could never get back on the track. Even though it was only for a few minutes, it represents a bit of normalcy after a long painful period.

Izzy sets the reference laps - and melted off its new center caps

MRI

I had my MRI yesterday to determine the fate of my toes and I'm still waiting for the results. I've logged into the site at least 5 times today hoping to find them but it look like I'll have to wait a little longer. I'm pretty sure the results will mean amputation but you never know. Mostly I'm hoping to stop the endless stream of antibiotics and get some energy back -- that's the biggest problem for me know.

Feet (again) SFW Pics

We have been waiting for my new antibiotics regimen to take effect before scheduling the next MRI to measure the state of the bone infection. While waiting, the gangrene cap on my right foot has started to detach. It's like a toddler loosing a tooth - first it moves a little, then it wiggles, then it flops around, then it falls off. Last night mine finally came off. Unfortunately it left some of my toe bone exposed. That needs to be treated right away - either graft on some skin or cut off some of the bone to close it up. Neither of those make much sense if we are going to amputate the toe in just a few weeks. So I need to do the MRI now to see if the infection has continued to spread. If not, we stitch up the one toe; if it has spread we are going to amputate them to remove all the infected bone. 

The Gross Foot Picture Reduction Act of 2015 is now in effect.

Workload

It has been tough first week, each day a bit harder then the last. I'm still struggling with a low energy level, partly due to liver and kidney function problems and partly due to the amount of antibiotics im taking to control the bone infection in my feet. I'm really looking forward to getting off the antibiotcs to see how it impacts this problem. Until then I will endeavor to preserver.

Major Milestone: Back to work

Today I started my new full-time job for a mid-size video product company in San Jose. It's quite an adjustment after many years of consulting. Unfortunately after 15 months of hospitalization and recovery, getting the consulting business going again proved too difficult. After falling off the face of the earth it's hard to get back on peoples radar. I also want to get back into a social environment where I can interact with others and work as a team. I kind of miss that. So I'm back at a 9-5 (at least) and working hard to get up to speed. It's nice to be back. I'll admit there was a long time when I feared this day would never come. I'm glad it's finally here.

Stratocaster modding

I decided to change the look of my Stratocaster by replacing the white pick guard and other plastic bits with black. My guitar is Lake Placid Blue (LPB) in color which is a common for Fender instruments and is almost always paired with white or ivory plastic. I saw a LPB Telecaster with black plastic at a shop a few weeks ago and thought it looked really good.

Installing the new parts was a little harder than I thought because I had to remove the guitar's neck to reinstall the pick guard. Here are the before, during and after pics. I think it looks a little "meaner" now. I still need to set the pickup hight and find matching black knobs and switch tip but the hard work is done.

Custom Shop Stratocaster as delivered

During Installation

New plastic bits and strings installed

Heavy Lifting

We got a small sandbox for Jackson. That "small" sandbox took over 400lbs of sand to fill. Filling was the hardest thing I've done in a very long time. 

How I feel better about my toes

Whenever I feel bad about my feet -- which I'll admit has been quite a bit recently. I found a sure-fire way to feel better. Simply google "gangrene toe images" or check out this site and look at the pictures.

Update

Here's what they look like now. #3 toes on both feet still show
remaining signs of gangrene. They look pretty gross.

Regular readers will remember that I'm still fighting an infection in the bones of my toes and feet caused by gangrene of my toes. The gangrene was caused by the use of vasopressors while I was sick. Vasopressors are a class of drugs that are given to increase blood pressure. The condition is called Symmetrical Peripheral Gangrene (SPG) which caused the flesh of my toes to die.

I've been on powerful antibiotics - first IV, then orally - for more than 9 months. All the while the infection has slowly spread, now involving metatarsal bones (foot bones) in addition to the phalanges (toe bones). It's becoming obvious that removing the infected area of those bones is the only way to stop the infection.

Unfortunately, that means removing all my remaining toes on both feet. Mechanically the human foot needs at least three toes to effectively distribute weight while walking. If you have to remove more than thee toes the remaining toes become overloaded and will develop sores and ulcers. My podiatrist is recommending removing the remaining 8 toes and one of the metatarsal bones.

Obviously this is not what we expected and is hugely disappointing. I thought I was well on my way to recovery and done with surgery and hospital stays.  

There is one glimmer of hope -- we are adding another even more powerful antibiotic to my current one in hopes of stemming the infection. To be frank, I don't think my doctors hold much hope, but for me this is the last chance. We will do another MRI in a couple of months to see if this new regimen works -- if not we will schedule surgery immediately after. Surgery will be two procedures, one for each foot spaced about 2 months apart, each followed by physical therapy session.

Hospital room 3206

There are few things worse than being in Hospital. I know, I spent last week there. It’s not really the Hospital that is so bad, it’s being sick enough to get there. I know, I spent last week there too. Another unexplained bout of nausea and vomiting started early Monday morning. I held out for a couple of hours, hoping it would pass. It did not. It was a classic CVS flare, intense nausea and vomiting every 15 minutes - endlessly.

Once I got to the ER, I gave the staff a bit of a scare - apparently my new compromised cardiac function looks like a heart attack on an EKG. Things got pretty exciting as they assumed the worst and started treatment. Luckily my Cardiologist was working the ER at the time and waved them off, explaining my condition and history.

As the vomiting continued throughout the day I was admitted late in the afternoon. It took 72 hours for the flare to finally subside and the vomiting to stop. Like last time Reglan (Metaclopromide) was the most successful treatment. I’m not sure what happened - Phenergan used to work really well for me but has basically lost it’s effectiveness in the last couple of years.

On Thursday I took a “Gastric Emptying” test. It involves eating a egg-salad sandwich laced with Barium and laying under an X-ray machine for a couple of hours while it passed through my stomach. I fell asleep after the first hour so it all passed pretty quickly.   

As is typical, this CVS flare has been followed by severe night sweats, soaking my night

clothes and bedding multiple times each night. Based on past experience it gonna last a few weeks. Speaking of experience, I realized I've been dealing with this for nearly 25 years. That is a long time.

One of the toughest parts of any Hospital stay for me is getting an IV. I’ve always been a difficult stick and this time was no different. I think I had 6 different IV locations between the back of my hand to my elbow joint on both arms. Even when they get one started, it seems to stop working within a day or two. Infiltration they call it when when the IV leaks and my arm swells like a sausage. It happened twice this time.

The other tough part of Hospital stays is the lack of sleep — Starting at about 5am the work cycle starts. First comes the 5am blood draw. 2-3 vials each time. Then the 6am blood pressure check and first medication cycle. At 7:30 it's breakfast delivery and at 9am another BP check — you get the idea. The cycle continues until the last BP check at midnight. All this activity doesn’t leave much time for solid sleep.

I left Hospital Friday night about 7 and slept most of the weekend away. I’m starting to feel stronger now — I took a walk with Kathy and Jax today and felt tired but good. So now it’s all follow-up appointments with my Gastroenterologist, GP and Cardiologist. One down and two to go...

Jackson photos

The Truth

I've worked to keep these posts positive, focusing on achieving goals and milestones. The truth is that somedays it really hard to be positive. Today is one of those days. Things ARE getting better, I'm a little stronger and little less tired most days, I can walk and ride my bike, but the truth is that I am a long way from "recovered".  I may not be "sick" anymore but I certainly not "well".

I still struggle daily with pain, sometimes so bad I can hardly get out of bed. And even after all the physical therapy I still struggle to lift my arms over my head or carry anything even slightly heavy. I have some pretty serious nerve damage in both my feet and legs that causes a mixture of hot pain and numbness. I still get light headed when I stand too fast and sometimes struggle with balance a bit when I walk. I still can't even look at my feet without feeling a deep sense of sadness and loss.

Next month will mark the anniversary of getting sick and I'm not sure how to deal with it. On one hand I'd like to celebrate simply being alive, on the other hand, I don't feel like it's really over yet.  I know I'll never be the same as I was before, I just wish I knew what I will be.

Recovery Update

It's now been 10 months since getting sick and my recovery is glacially slow but measurable. I've been on the bike a couple of times -- sticking to the flat roads in our neighborhood. Hopefully a little regular riding will help address my chronic low-energy situation.

I rode 5 slow miles on Saturday which totally wiped me out. Recovery is equally slow, taking many days to recover from each ride. I'm obviously riding pretty slowly -- less than 10 mph so leg strength is really not a factor yet. The limiting factor is my shoulders, which are only strong enough to hold my upper body steady for a few minutes before wearing out. My hands also get tired pretty fast.

At my slow pace I'm not really getting into the cardio zone yet so I can't really judge how my new heart responds to training yet. I hope it will be OK.

Yesterday marked the first time I did a bit of resistance training, riding over the elevated pedestrian bridge that spans one of our local expressways. It's about 100 feet long and climbs about 30 feet. Short and stiff. I used to do sets of 10 out-of-the-saddle sprints up each side.

Now I ride it once each way -- which is more then enough. It awakened a number of unused muscles in my back and hips which remain sore this morning.

I think my cycling is more rewarding spiritually than physically but right now that's just fine. It just feels good being out there.

Back in the saddle

After months of anticipation I rode my bike today. It wasn't far or fast but it was a real ride -- helmet, gloves, heart rate monitor -- the works. The ride itself wasn't too bad, I used my monster-cross, a large-tired cross bike made by Black Mountain Cycles. It's got a really smooth ride and I sit a bit more upright than the Hakkalugi race bike. Still my shoulders were the limit, getting sore after just a few minutes.

It was a emotional event, Sunday morning bike rides have been a tradition for me for more than 10 years and restarting them marks a return to normalcy. During the ride, I was overcome with emotion as I remembered laying in the hospital bed dreaming about riding again. Today that dream came true.

Link to Strava

Cooking again

It's a sure sign I'm getting better. Tonight I cooked dinner. Bacon wrapped pork tenderloin and pomegranate jus and baked potatoes with all the fixins. Couldn't find anything green. Easy, quick and delicious. #live4food

Jax drives the bus

Progress?

Just before christmas (on my birthday to be exact) I had an MRI to determine how 6 weeks of IV antibiotics was doing to the bone infection in my toes. IT's the first time I had both feet done. The first MRI was only the left foot because that's where the open wound was. After that MRI I went in and had some of the 2nd toe on the right foot removed. That foot has been healing nicely so nobody expected any infection there. We were wrong. In fact the right foot has involved 4 toes (only 3 are involved on the left). This is an unexpected setback.

About the same time I got a complete blood work-up confirming that my kidneys are still damaged causing anemia and low hemoglobin levels. This is why I still feel so tired all the time.

All in all not much good news for the christmas holiday.

In response we are stopping the IV antibiotics and starting another kind orally. Taking a pill is a lot easier that shooting up three times a day.

Today I had another visit to the surgeon who took my toes. Things look pretty good there - everything is healing nicely - and I got permission to take showers without using "dry socks" to keep my feet dry. This combined with the removal of the PICC line means I can now take a shower without any waterproofing for the first time in nearly 10 months. Until now it's been "dry-socks" and wrapping my arm in "Press-n-Seal" wrap and waterproof tape. It takes like 10 minutes just to get ready to shower and another ten to take it all off. I have to admit I've been looking forward to simply walking into the shower for a long time and today was a pretty nice milestone.

The "tank"

Jackson came to one of my last Hyperbaric treatment sessions to check things out...

Jackson inspects the Hyperbaric chamber

Who's that?