Boris Phenobarb Reduction #2

Its been 5 months since the seizures and we have seen no more.
We had another bloodtest done and all the blood levels look good - both for the phenobarb and for the liver enzymes.  So the Dr has decided to go for another reduction in phenobarb.
We are now down to 24.3mg, which is 1.5 16.2 mg tablets.  This means cutting tablets in half which is no fun, but we are now down to HALF of the original dosage.
Keeping my fingers crossed that this all goes well.

Right Shoulder Progress Recap

Looked back through the blog to see how progress went o the right shoulder.
Just wondering what kind of timeline to expect for the left.

Dec 3	Day 0	Surgery -  Left wearing sling with bulky pillow to hold arm away from body. Start sleeping on easy chair in den.
Dec 9	1 Week	Stitches out.  Started home PT.  Doc says I don’t have to use the bulky pillow under the sling, but recommends wearing sling to remind me NOT to use the arm.
Jan 3	1 mnth	Doing home PT and stationary bike
Jan 6		Cleared for PT - PROM and AAROM
Jan 11		Started PT - painful, limited ROM
Jan 18	1.5 mnths	Started AROM
Feb 1	2 mnths	4th week of PT Strenght – can lift arm overhead without assistance!   YAY! As far as range of motion: Flexion (raise arm forward to overhead) - 176 degrees out of 180 Abduction (raising arm sideways to overhead) - 180 degrees Internal Rotation - 90 degrees (out of 90) External Rotation - 76 degrees (out of 90)
Feb 13	2+ mnths	Rehab Report - 75% ROM, but limited strength Last week I could not lift 2 lbs over my head - I could only manage a 1 lb weight. Today, I was able to lift a 5 lb weight over my head, slowly.
Feb 28		Rode Mtn bike on road – 32 miles
Mar 1		Climbed 5.7
Mar 3	3 mnths	Not bad during the day, but pain in the middle of the night wakes me up
Mar 9		climbed 5.9 at silos
Mar 12	3.5 mnths	85% mobility, pain in middle of night
Apr 3	4 mnths	Riding, lifting, climbing; less pain in middle of night
Apr 13		Climbed 5.10 at silos
May 3	5 mnths	Strength good, but not for hard activities
May 29	~ 6 mnths	Adventure race, 3rd place (short kayaking section)

Cancer Excision Surgery

The term sounds technical, but it simply means cutting out the chunk of skin surrounding the tumorous growth.  Ok, so its not all that simple, especially when its one's own arm.

Luckily, the growth was out in the middle of my forearm and not near any joints, bends, buldging veins, etc.  So the Dr had a nice open piece of real estate to work with. 
First, he marked off the area to cit with a pen - in the shape of a football with a few millimeters of clear skin on all sides of the growth.  He needed to get enough extra skin to ensure that all the basal cells are removed.  The removed skin will be biopsied along the edge to determine whether the basal cells extended that far out.   The football shape was to make the open area easy to suture.
Next was a few well-placed injections of lidocaine to numb the entire area, then he went to work.
And I got to watch - pretty fascinating to watch someone cutting into your own flesh and not feel a thing!
Using a small scalpel, he cut along the marked boundary and gradually deepened the cut to go through ALL layers of skin.  I asked him how he would know and he said it is when he sees fat.  Hmmm... OK!
After cleanly cutting the entire boundary, he then cut under the patch to separate it from the body.  After removing the patch, about the size of a quarter, he used a little electrical device that resembled a miniature arc-welder to cauterize the few bleeding veins.  Surprisingly, there was not nearly as much blood as I would have expected.
The next step was suturing.  First he put in one stitch directly across the center of the football area and pulled it tight to close the opening as much as possible.  This was done with an absorbable suture, probably catgut.  Then he switched to nylon sutures, putting in 4 alond the length of the incision to close the wound.  It was really interesting to watch the meticulous technique of putting in each stitch.  It was amazing to see how tough my skin was when the pulled on the sutures to tighten the knots.
All done!  Afterwards, he applied some kind of adhesive to my skin, then laid a small section of thick gauze directly on top of the stitches, then taped it down with a large piece of gauze-looking tape.  He did a second layer of the same.  He said with all the adhesive on there, it would not come off.  I kind of figure that it will really hurt when its time to pull it off.
He said to leave the bandage on for at least 5 days, then to return tothe office in 10 days to have the stitches removed.
I got to admit, it was a really cool experience, but I do NOT want to go through it again.
From now on, do NOT forget the sunscreen - EVER!

Shoulder #2 - Your time has come!

I got a call from my orthopedic doctor today.  He was calling with the results of an MRI I had on Monday.  My left shoulder (the "good" one) had been bothering me more than usual in the last few months, so I had it checked out.  As we did witht he right shoulder, he gave me a cortisone injection with the hope that it was just inflammation, but when that didn't help, he suggested an MRI.

The results of the MRI - "partial thickness tear" of the supraspinatus tendon.  They radiologist estimates that it is 50% torn.  The general guideline is that when a tear reaches 50%, then it is time for surgery to repair it.

So I guess its time to get it done!

Here are some links that better explain it...
http://www.shoulderdoc.co.uk/article.asp?article=1368

http://www.shoulderdoc.co.uk/article.asp?article=1251&section=22

cancer, with a little c

I got a call from my dermatologist today.  I had gone in a few days ago to get an examination of a small bump that had been on my arm for a few years.  It had just recently become irritated and tender to the touch.  They had taken a biopsy and were calling with the results.

As it turns out, this bump is a basal cell carcinoma, aka cancer.  The good news is that this type of cancer rarely metastasizes (spreads), but usually just destroys surrounding tissue.  He said I would need to have a small surgical procedure to remove it.

Cataract Surgery Pre-Op

I had my cataract surgery pre-op today.  This is where they put me in front of a half dozen various eye measuring devices in order to get all the information to properly plan the surgery.

This is also where we discussed the options for the IOL (intra-ocular lens).  The options are:
1)  a monofocal - the traditional lens, what mom and dad have
2) a multi-focal - the light is split into multiple images to help with near, mid, and far vision
3) an accommodating lens - the lens flexes as the eye muscles try to focus, this mimics the natural lens

Of course, each has advantages and disadvantages.  The accommodating sounds the most promising, but is also the most risky.

Tough decision. VERY TOUGH!  This is my eyesight!

What? Cataracts?

So I have cataracts!  At just over 50! 
Most people get them in their late 60s and 70s, but I am one of the lucky ones to get them earlier.
About 2 years ago, I started noticing that my night vision was getting worse.  So I went back to my opthalmologist, who informed me that I had the start of cataracts.  He told me that the type of cataracts that I had were the kind that affect people even in their 20's and 30's.  He also warned me that this type of cataract usually progresses fairly quickly.
Well, he was right!  For the past 2 years, I have been having to get new glasses every 3-6 months.
Finally, on my last visit in February, he told me that I was now "medically qualified" for cataract surgery, which means that now my health insurance will pay for it!
So now I am looking at having the procedure done in April