02 March 2018

Out Come the Stitches


Second Post-Op appointment came and with it looking forward to removal of the stitches and hopefully a boot rather than a cast.  With a cast, I would still need to take baths.  If I got a boot, then I could take it off and take a shower.

Dr. C was pleased with how much the swelling had come down, no sign of infection, and looks like no residual bleeding.  So, she began to take the stitched out.  One by one, only pressure, but no pain.  Until the last two.  She asked me if I had taken my Percocet or other pain med.  I said no, and asked why.  She said, these last two look like they may cause some pain- closer to the bone/joint.  She told me to lay back and relax.  She tugged, I breathed and watched my Fit Bit heart rate come down and down, and down (84...72...66...58...52...) and getting a little lightheaded as I felt a lot of pressure and pain.  I did not pass out, but saw my heart rate drop to 47 as she said, "I'm finished with that part."  Whew.  I was glad, then I thought, what did she mean 'that part'...?

Well, what she continued to say was "Are you OK?  The next part is usually the worst."  Really?  I thought that was pretty bad.  I would say 6-7 on the pain scale.  Not quite unbearable, but...

What she meant was the three stitches at the tip of my toe where the screw went in are the most painful for the patient.  The screw head is flush with tip of the phalanx, and close to the skin, where the stitches are located.  Not only is there pain from the incision, the area is very tender due to the screw placement and the healing of the bone around the screw.  Here we go again.  Fortunately, there are only three stitches, and she had them out quickly and was not nearly as bad as she anticipated.

No Cast!

She cleaned up my foot and ankle and checked out the incisions.  Swelling was markedly improved and the bandages and splint she took of was not dirty.  That meant I was not walking and obeying her orders! That meant she could trust me with wearing a boot.  If she saw evidence of walking, still swollen, and reddened- incision area, it would a cast for the next six weeks to force compliance!

 The Boot

This meant I could take a shower!  And see my ankle and foot!  So, I would see Dr. C in five weeks for another X-Ray and start partial weight-bearing.  This assumed I continued to obey and not walk on my foot until then.  Crutches and the boot for five weeks.  I will get my upper body workout!


I thought this was funny.  We ate at IN-N-OUT on the way home and found the 'handicap' table was the most comfortable, so I had to take a picture.  I got to go 'Out' and enjoy the outside world!


 Left versus Right.  Easy to tell...

Taking a shower was awesome.  After 16 days, it was refreshing.  Being in the military, I have gone for many days without a shower, but never this long.  I can also see that my right toe that is  a little shorter than before, but not much.  Dr. C said to expect this due to the fact that the cartilage was removed at the joint.  This was the first time I saw both my legs and could see a marked difference between the Left and Right legs.  I have a ways to go to get my running legs back in shape!

Post-Op Checkup

The Checkup

Here we are at D+10 and time for my first post-op checkup.  My first trip since going under the knife and was nice to get out and feel human again!  Unfortunately this visit also included X-Rays.  This was probably the most painful moment since the surgery.  The technician had to help me pull back my toes so my big toe (aka First Hallux) was by itself for her to get a good picture for the surgeon.  Suffice it to say, my entire foot and ankle were very stiff and painful to move.  After several minutes of trying to manipulate my foot, ankle and toes, we finally got a good picture.  Unfortunately, I did not take any pain meds before the visit, nor did I bring any to take after today's poking and prodding!

Anyway, this is what my foot looks like at D+10.  Funny, one can still see the surgeon's initials on the top of my foot.  Dr. C warned me about the surgical site looking worse than it really is.  The dark black lines are actually the ink she used to mark the incision site, it is not dried blood!

The incision starts at the medial side of my big toe, comes across the top of the IPJ, and continues down towards the lateral side of the toe.  This allowed the surgeon to open up the joint, remove the cartilage, ream/drill the intermedullary canal where the screw will go.  The second incision is at the tip of the toe where she will continue to ream the canal where the screw would be inserted and drilled through the Distal Phalanx, through the IPJ, and into the Proximal Phalanx.  The screw would be counter-sunk into the Distal Phalanx so as to not 'stick out' and cause problems with wearing shoes or running. 

 It looks worse than it feels!

The screw would naturally compress the two bones together at the IPJ and over 6-12 weeks would heal like any broken bone would do.  So, over the next six months, the joint will continue to heal and become one fused bone, rather than a distal and proximal phalanx, it will be distimal phalanx!

Dr. C was pleased with the healing, but the stitches were not ready to come out.  She replaced the Steri-Strips and re-bandaged the foot and ankle.  Her only concern was there was no signs of bone healing yet, but no worries.  Everyone heals at a different rate.  She reminded me to not poke or scratch at the foot and ankle.  And continue to obey her (and my Wife's) instruction and NO WEIGHT BEARING!!!

It is probably all in my mind, and when talking to Dr. C and reading up on ORIF (Open Reduction, Internal Fixation), I realize the sensations I feel are part of the healing process.  When I think about the 2" Screw in my foot, I can almost talk my self into feeling the screw.  I know that I can't really feel the hardware, but I swear I can feel it!  It is a weird sensation in the foot, but those sensations will gradually go away.

 The Screw, and it is not loose!

This is why they want the patient out during these procedures!  Being in a dentist chair and hearing the drill is uncomfortable enough!  I could not imaging the sensation, albeit only pressure with no pain, of seeing the surgeon pull out a big ol' Black and Decker drill and drill out and ream a bone in your body.  Ugh. 
Not the Actual Drill...

We Have Come a Long Way

Go back only 150 years to the U.S. Civil War and think about how we conducted surgery.  It was rather simple:

1.  Get Shot by a musket ball.
2.  Hope not to bleed to death as you are carried back to a barn, house or church.
3.  Lay in line hoping the surgeon sees you in time, again hoping not to bleed to death.
4.  Buddy lays you on the blood-stained kitchen table or pew.
5.  Surgeon says, 'the leg has to come off before infection sets in!'
6.  One person gives you a big stick to bite down on and gives you a big swig of whisky to help with incoming pain.  Another soldiers lays on top of you to keep you from moving.
7.  Hopefully you pass out at this point.
8.  The surgeon wipes off the saw from the last amputation and begins to saw...
9. If you survived this far, and haven't bled to death you would possibly still die of infection.

One of My Convalescent Leave Tasks

One of my tasks to complete during this time of recuperation was to design an album of paintings my mother-in-law has done over the years.  This is part of my in-law's 50th Wedding Anniversary.  It is called 'Blue Heron Studio' and has painted may different works of art over the years.  It came out pretty good, and hopefully she will enjoy the finished product. 

01 March 2018

The Routine without Drugs...

D+3 through D+7
The Routine

For the next five days, I developed a routine.  Get up as normal and take a 'bath' after everyone else had theirs and were about their day.  I never really slept well on my back and on top of the bedsheets.  I would wake up every 2-3 times a night as the pain medication wore off.  Or, more commonly, I had rolled over and found a sharp pain shooting up my foot because I had bumped it in the night.

By the following Sunday, D+5, I stopped taking the Percocet and started taking Motrin/Ibuprofen.  I did not like the side effects.  I did feel a little uptick in pain, but was not worth the constipation, dry-mouth, nausea, and loopiness it gave me.  I was also edgy to my family when I took the pills.  The pharmacy gave me enough Percocet to last me two years, it seems.  Way too many!

The worst, I will say, was the constipation.  They gave me a laxative to take along with the Percocet.  But when you finally have to 'go' at three in the morning, sitting on the toilet with all the blood rushing to your foot makes for an extremely painful experience.  Not worth it!

Maybe it is just me, but the 'feel good' was there for a little bit after I took the Percocet, but I didn't feel the need to continue to take the meds.  I certainly wasn't Dr. House and had to have my fix every four hours.  However, I did some research on the couch.  Now, I don't have a chronic pain condition that the fictional Dr. House had, nor real people with real chronic pain.

However, I do have an appreciation for how it could be easily to become addicted.  It is my understanding that addiction is nearly non-existent up to around the initial five days of use. However, when someone crosses the 10th day, addiction skyrockets.

I just hope my unit Drug-Demand-Officer doesn't announce a drug-test in the near future.  Looks like my spit and pee are good-to-go.  But lay off my hair...

Sadly, I was in no shape to go to church on Sunday.  I was able to watch all of it on Livestream, which is a great ministry our church does for those who are not able to physically attend.  I would find myself doing this the next Sunday, too. 

28 February 2018

Feeling Good!

Feeling Good!

Of course I was feeling good.  I couldn't feel anything below my knee, couldn't see my foot, and was able to relax on the couch.  The only problem was the impending pain that would come in 12-18 hours when the nerve-block would wear off.  That would occur sometime around 3am Tuesday morning.

The Percocet would be helpful to get me past the initial few days of pain as the block wears off. 

My view for the next few days, a lot of Ice on the foot!
I would be bed-ridden for the next few days.  Once the blocks wear off, then I would be able to feel where my leg was.  I was very afraid during this time that I would hit my foot and toe using the restroom or moving about a little.  There was blood/drainage from the incisions, and all I could think about was that I had hit my toe and either tore open the incision, broke the screw, re-broke the toe, or something worse. 
Not Remembering
After the surgery when I was still 'out', R talked with the surgeon.  Dr. C told her a few things:
1.  During the surgery, she found the culprit of my ongoing pain that was hiding in the CT and X-Ray. Two bone fragments were dislodged and had moved into the joint.  This was causing my chronic pain.  She decided to remove these fragments and not plate or screw them back into place.
2.  Dr. C had to cut the Extensor Hallucis Longus Tendon.  This tendon attaches along the metatarsal and phalanges of the top of the foot and big toe.  It is what allows us to dorsal-flex our foot upwards.  This was one of those "potential problems" we talked about during the pre-op appointment.  The tendon was strained and out of alignment because of the fracture, and she was not able to move it out of the way in order to get to the joint.  So, she had to cut the tendon above the joint.  
The Tendon that had to be cut at the IPJ of the Big Toe
So, if the only serious problem is having the tendon cut, not so bad.  It only means a little longer to fully regain the flexibility of the foot and toe.  I'll have a bump on the top of my toe where the tendon was reattached to the metatarsal, and a little shorter in length.  Hopefully, I can slowly stretch out the tendon to the original length over time.
I suppose I won't miss those two fragments.  Dr. C said since the joint if fused, you don't need them anyway!

Here Comes the Pain
D+0 and D+1
I took my first pain med before heading off to bed.  Well, I really didn't 'head off' anywhere.  I stayed where I was, on the bed.  I only got up to use the rest room and wash up a little.
As a side-sleeper, I knew sleeping on my back was going to be the most difficult part of this.  However, when I took my first Percocet at 10pm, that was no longer a problem!  Until about 4am, just like clockwork.  I could feel the meds wearing off, along with the nerve block.  When I attempted to get out of bed and take another dose, gravity took over.  I didn't fall, but when I swung my legs off the bed to crutch to the bathroom- I quickly discovered the pain and blood rushing to my foot. 
So, I put my foot back up above my head and tried it again slowly...
It still hurt, but was bearable.  I was able to use the restroom and take another dose.  I set my alarm for every four hours to take the meds.  I kept the meds at my bedside for future use!


Getting Ready for Bed
I got into a routine of slowly ambulating around on crutches and sitting on the couch rather than in bed.  I managed to take a bath on the second day post-op (D+2).  Actually, not a bath, but sitting on the side of the tub and wash up and feel normal. 
I began working on my 'assignments' on Thursday.  The Winter Olympics were starting today, so good timing for me!  I had some items I wanted to get done since I would be home for 3-4 weeks. 
1.  Do our 2017 Taxes
2.  Go through all our photos and put them together in albums. Nothing fancy, just go through and organize.
3.  Blog- this one.  About my experience.  Not like most of what I read with other people's experience. I'm not blogging about 'Embrace your Pain', 'Accept your Circumstance', 'Acknowledge your Discomfort', and 'Mindfulness and Mending'.  Ugh.  Spare me that stuff.  I broke a bone, it hurts, doctor fixed the bone, hurts more.  Move on.
4.  Read.  "Medical Response at the Pentagon on 9/11", "Echoes of Glory:  Battle Sites in Texas", "Reformation Guide to Scripture", and several professional journals.
5.  Pod Casts:  Catch Up!  Civil War Podcast, Wretch Radio, Al Mohler, Truth for Life, and Freakanomics.
6.  Watch the Winter Olympics.  Live.  Why not?  I'm up at 4AM taking my meds anyway!
7.  Create a large 'Coffee Table Book' that contains various pieces of artwork of my Mother-In-Law.  This is part of a larger gift to her and my Father-In-Law for their 50th Wedding Anniversary.

OK, time for a break and take my pain meds!

And Then I Woke Up

And Then I Woke Up

"I can't feel anything below my knee."  That was my first comment when I woke up, according to R. 
Something else I think I said was "When are we going to get the surgery started?"  And the my nurse said something like, "It's over, you are in recovery.  Your wife will be able to come back in a few minutes."

Actually, the only thing I clearly remember is waking up at home a few hours later.  Anesthesia is a wonderful addition to the world of medicine.  I woke up to my foot and ankle bandaged and not feeling anything.  It wasn't long before I was able to put on my clothes, very slowly.  I had no control over my right leg, so I had to carefully not bump or stand on it. 

When an infection outbreak happens, blame the staff and Central Sterile!
Fall Risk

One picture I did take before we left was of my 'good foot' where there was a 'Fall Risk' warning tag.  I certainly was.  This made me feel like one of my cardiac rehab patients back when I was working in the hospital.  I am used to placing this on geriatric patients, not being the recipient of one! 
Watch Out, Fall Risk!
On the way home, R stopped at a Texas Favorite for lunch.  I hadn't eaten since before 6pm the night before, so it had been going on 24 hours since and I needed to get something in my stomach in order to take the potent pain medications.  Again, I don't really remember.  


Never 'NO' Again

Never 'NO' Again
After today, Monday February 5th 2018, I will have to check 'YES' when asked if I have ever had surgery or other medical procedures. 
Here I am, with my awesome wife, who will take care of me for the next few days while I am couch-ridden until I am able to move around on crutches.  We check in and am taken back to the pre-op area.  I meet Dr. C, my pre-op nurse, the CRNA and the process begins. 
I am anxious, and hungry!  Dr. C writes her initials on my left foot, and am asked for the 756th time my full name, date of birth and what I am having done.  And...
1.  No, I have no allergies.
2.  No, I have had nothing to eat since 6pm yesterday.
3.  No, I don't have diabetes.
4.  No, I don't have a fever (didn't the thermometer tell you that four minutes ago?)
5.  No, I don't have any open cuts on my foot (didn't you just examine my foot two minutes ago?)
6.  No, I don't consume any tobacco products.
7.  No, I have not consumed alcohol, If it would help, this is what you could get me downstairs...
8.  My full name? Again?
9.  My full date of birth?  Again?
10.  What am I having done today? Again?
Most of this is in jest.  I have worked in hospitals for years, and wrong-site surgery and near-misses are a real thing.  It can be frustrating for those who have never been part of an investigation of these issues.  I have, and they are not fun, especially for the patient. 
So, my nurse shaved my foot, and got out the multiple drips and IVs.  She was very good at her job and helped allay much of my nervousness.  I wasn't nervous, but just couldn't relax.  They let my wife, R, come back for a few minutes.  I did have to take off my clothes, except I could keep my underwear on, but everything else had to go.  I asked if I could keep my Fitbit watch on as I was curious to see the various metrics, but was told no.  Oh well.
So I put on the compression stocking on my good leg, the CRNA came in did an ultrasound so she could mark where she would inject the nerve blocks.  She said there would be three: at the ankle, behind the knee and somewhere on my thigh.  As the nurse got the IV started, I was feeling a little more comfortable. 
So far so good.  I watched my nurse hang a couple of bags of IV solutions, and I continued to watch the monitor hoping to help my blood pressure come down. It started at 134/92, which is very high for me.  As I relaxed and breathed more regularly, I was able to get it down to 122/82.  Much better.
The nurse covered me up with a blanket and checked the IV bags again.  She took one bag and hooked it up to my IV.  The CRNA and the assistant got out the various nerve block needles and continued to verify the locations with the ultrasound. 
Then I asked the CRNA, forgetting that she had just told me, "How many nerve blocks do you do for this..."
I never finished the question...

Decision Day

Decision Day

Thursday, January 4th was my follow up with the surgeon to check on the results of the steroid injection and to make the final decision.

The injection did help reduce swelling, along with the icing and rest of the foot.  However, there was minimal pain reduction.  The continued pain perplexed the surgeon, as she thought the pain should have subsided, but that is an issue I will address in a later blog.

Needles don't usually bother me, but the steroid injection I talked about earlier was not too bad, it was the pressure and knowing what was going on.  The orthopedic tech told me, jokingly, that if you think this was bad, wait until your day of surgery and the post-op poking and prodding!  I always joke about needles and that I USUALLY don't have problems with them. 

The only exception is when someone starts to 'fish' for veins if they don't hit it at first.  When I was a new Evacuation Platoon Leader as a 2LT, we would routinely train our medics on starting IVs.  My Platoon SGT would routinely ask the rookie-medics to start IVs on the senior medics, and me.  I was the perfect pin-cushion as they had about 20 seconds to find the vein, and if they didn't find it and began fishing, I would pass out!  No pressure....

You Might Die, and Other Things...
It is one thing to sit on the clinical side of an Informed Consent and know that odds are nothing will happen and all will go as planned.  However, one must go over what MAY go wrong.  Infection, non-union, hardware may break, tendons cut, nerves severed, and other items.  When going over all the possible complications, one stuck out.  You may die.  Of course this has to be said and discussed.

However, on the more humorous side, I thought about a situation that must be addressed.  I didn't update my living will to include what should happen if the Zombie Apocalypse happens while I am unconscious?  If Rick Grimes had updated his, then he would not have had to deal with leading people around Georgia for eight years.  That was my real concern!

I did not want to wake up and see this.  If the zombies break through, just put me out!
It is a Go!

Monday, February 5th is surgery day.  All the paperwork is signed, Convalescent Leave is approved, work is covered and I have my non-weight-bearing assignments ready for me to accomplish.

My surgeon showed me the X-Rays and reviewed, again, what I should expect before, and right after surgery.  She showed me what my toe will look like afterward the surgery.  Bottom line, there is no going back.  Open up the joint, remove the cartilage, smooth the distal and promixal phalanges, drill a hole from the tip of my toe, through the both phalanges, take a ~2 inch titanium screw and insert it down the drill-hole.  the screw will compress the two bones together and over 8-12 weeks will become fused. 

 Not my X-Ray, but what my Right Hallux IPJ will look like after the fusion
Of course, as I researched this procedure, if I obey the weight-bearing instruction by the surgeon, I could be back running in June or July.  That means no weight-bearing for six weeks, partial weight-bearing for another six weeks, and then finally back to street shoes after 12 weeks.  A long time, but now there is an end in sight!

Military Medicine Firsthand Experience

The First Surgical Consult
On Thursday, November 17, I had my first appointment with the Orthopedic Surgeon at Brook Army Medical Center.  Working at the Army Medical Command for the past two years, I am aware of the significant changes coming in Military Medicine.  Purple Medicine is coming.  My initial surgical consult with an Air Force LTC.  He explained the procedure in gruesome detail!  It was what I expected.  He wanted to wait and try a steroid injection first to continue to reduce the swelling and get an updated CT. 
He also recommended I have a second opinion because of the "permanent solution" to my pain.  Fusing the joint is a serious decision, especially with the big toe and the secondary effects of weight-bearing activities and compensation of the other joints. 
Brooke Army Medical Center, Fort Sam Houston, Texas
Second Surgical Consult-CT-Steroid Injection

My second opinion was scheduled for Tuesday, December 19th at Wilford Hall Ambulatory Surgical Center (WHASC).  At Lackland AFB, this is the primary health care facility for Lackland AFB and beneficiaries on the west and south sides of San Antonio.  In the 1990s, Congress mandated that acute care services at WHASC be moved to BAMC.  With this, routine and outpatient services moved to WHASC. 
I had my CT and XRAYs completed at BAMC prior to my appointment at WHASC.  My appointment was with an Army Podiatric Surgeon.  So, I saw an Air Force Surgeon at the Army Hospital, and an Army Surgeon at the Air Force Hospital.  Interesting.  What takes the cake is the providers at either facility cannot access radiology reports from the other facility.  Talking to a colleague at the Defense Health Agency (DHA), Purple Medicine, said this is due to old contracts that are still in force that have proprietary aspects. 
So, at WHASC, my surgeon, (I will call her SJ), fortunately was able to get a CT that morning and could see the exact issues.  The only problem is I had to hang out for a couple hours.  She also said she did want to try a steroid injection.  I said I have one schedule for January 5th at BAMC.  She said, "Let's do it now!".  OK...
I will say when she and the assistant manipulated my toe (and the broken joint), it was not a pleasant experience.  

Wilford Hall Ambulatory Surgical Center
So, my toe and foot hurt for several hours afterward, with the hope that the effects of the injection would take hold and reduce the swelling and pain.  I would find out on January 9th if any progress was made.

19 February 2018

Boot, Insert, Plate, Repeat...

Boot, Insert, Plate, Repeat...
On September 19th, 2017 I had my first orthopedic appointment at Brooke Army Medical Center (BAMC).  Between the orthopedist and the podiatrist, they agreed that I had two choices.  First was surgery now and minimal pain later.  Or chronic and worsening pain for the next few years resulting in surgery later. 
Hmm...didn't seem like there is much to dwell on in this scenario!  The reasoning was that the fracture was in the joint and since there are bone fragments not healing, any wrong step could dislodge these fragments and cause even more damage to the surrounding tissue.  Not Good!
Also, and just as important, these types of fractures (in the joint), will speed up the arthritic breakdown of the joint based on activity level.  And based on my activity level, running, trailing-running more specifically, would further speed up this process. 
However, the joint was still swollen and sore when the doctor worked the joint through a series of range of motion exercises.  This did hurt!  So we began down the road of reducing the swelling and giving the joint some rest. 
The Boot
So, we began with the Boot.  For four weeks.  Wear it all the time except for bathing and sleeping.  No running.  So I began my gym workouts.  I do not like the gym.  I would prefer to be outside running, even if it is 110 or 10 degrees!  I would need to ice/heat my foot four times a day.  This was a pain as when you wear one, you have to put an insert into your other shoe so your feet/knees/hips/back remain even.

The Boot
 The Insert

October 24th, I returned to BAMC for a checkup and to see how the joint was doing.  It was stiffer, but less swelling.  That was a good thing, but also I had more pain in the joint, which kind of made sense.  However, it meant that probably the fragments were not healing and continued to move causing the pain.  The next 'step' was to keep the ankle from stiffening and the Doc moved me to a stiff shoe insert.  At least I could wear normal shoes and boots again.  Its purpose was to keep my foot and toes from flexing and aggravating the joint.  We would try this for another three weeks then come back for a follow up appointment.

The Carbon-Fiber Plate Insert
The final attempt to reduce swelling and stabilize the joint was this little beauty.  An insert that would not allow any motion at the great toe joint.  I certainly did its job, but the side-effects were worse than the pain at the joint.  I could not tolerate this it caused a significant amount of pain across the metatarsal heads of all toes and inflamed the arch of the foot.  I could not wear this as prescribed. 

Final Follow Up
The week after Thanksgiving on the 28th of November, the Podiatrist saw me for our final follow up and basically said, it is time to take it to the next level of treatment- Surgery.  The follow up X-Rays showed the same as before, no changes in the location and healing rate of the fragments.  So, we scheduled a visit with the Orthopedic Surgeon for pre-op evaluation. 
My podiatrist gave me an overview that didn't sound too appealing!  He told me he has done hundreds of them over his career, but his surgical days are behind him and that the 'younger whipper-snapper surgeons' have a much steadier hand than he does.  The process would be to fuse the joint.  Permanently.  He recommended surgery because it would be inevitable based on my activity level, age and the fracture at the joint. 

Go for the surgery now while I am young and can adjust biomechanically now rather than wait and have a more difficult time at a later age. As an added bonus, I will have this surgery done at a world-class facility by a health care team that is second-to-none in helping Soldiers-Sailors-Airmen-Marines recover from injury and illness.  

The diagnosis...

The Diagnosis
"Displaced, Comminuted, Intra-articular Fracture of the Distal Phalange of the Right Hallux with >2mm Displacement"
In plain English, Please!
1.  Displaced- the Interphalangeal Joint (IPJ) of the big toe is dislocated laterally (to the right).
2.  Comminuted- more than two pieces of bone are fractures and not attached to where they should be attached to.
3.  Intra-Articular- the fracture occurs in a joint.  This is BAD.  This means that I have a jump-start on arthritis (more about this in a later post!)
4.  >2mm Displacement.  That means the dislocation is not only laterally 'out of joint', but it is horizontally depressed across the joint.
The X-Ray.
I am fortunate to work with some great people at the Army Medical Command's Center and School at Fort Sam Houston.  I work with Nurses, PAs, PTs, Combat Medics, Physicians, and many other highly skilled providers.    This is how a few of those friends explained my X-Ray to me. 
1.  This is the Distal Phalanx,  It should be pointing straight ahead, but it is not.  It is displace laterally towards the second toe.
2.  This is the fracture line where the distal phalanx is in two pieces.  The Proximal piece is still attached, as it should be, to the joint.  Unfortunately, the distal piece of the Phalanx decided to do its own thing and broke off and became displaced.
3.  This is piece one of the Distal Phalanx that has a hairline fracture.  This is the fracture point that involves the joint, as it is separated from both pieces of the Phalanx.
4.  Another piece of the Phalanx that is fractured and not attached to any part of the phalanx.  Never good to have a piece of bone just floating around.
5.  A smaller piece of the Phalanges that is fractured.
As one could imagine, this hurts.  Because of this X-Ray, my Doc asked me again, "How long have you been walking on your foot like this?"  He answered for me,  "Too Long, right?"
My next stop was with the Orthopedic Specialists at Brooke Army Medical Center. 
Should I say this again, I have never been a 'patient' before.  I have always been on the other side of the Healthcare System!
Now I go into uncharted waters...

17 February 2018

Broken, but not out!


While my family was away for our church's youth Summer camp, I carried on with my usual activities, including my weekly trail run.  This week, I decided on a longer run outside of San Antonio since I didn't have anyone at home.  Eisenhower Park is a beautiful park by Camp Bullis on the north side of San Antonio and has nice improved and semi-improved trails with long gradual inclines and a few steep ones.  Many trails traverse the single hill that includes a wooden overlook where one can see for miles in each direction. 


I have sprained and strained muscles, tendons and ligaments over my lifetime.  Run and hiked plenty of trails and have come to expect the usual twists and turns that my ankles and knees have endured.  I have never broken a bone. I have come close, but never a clinically-confirmed diagnosis!

Until Tuesday, July 12th 2017th. 

I just finished the 2.5 mile upward trek to the Overlook at Eisenhower Park, and on my way down.  I decided, wrongly, to take a switchback on my descent.  I usually can roll with the loose rocks and gravel I encounter.  This was not a new area for me.  However, this time I hit some rocks that were not loose and my foot ended up wedged in the crevice as my body kept going.  It did hurt, but not so much at the time. 


It did hurt, but it was my ankle that I figured I sprained, not my foot so much.  Recognizing the pain was not normal, I slowly walked/jogged lightly the last mile back to the car.  When I got home, I did the correct things, iced and elevated my ankle and foot.  I took it easy and hobbled around for the next few days.


I did not go to 'Sick Call'.  That is the Army's way of dealing with an illness and injury.  One goes on 'Sick Call'.  It means sitting in a large waiting room with a bunch of sick and diseased soldiers for hours waiting to be seen.  In my 26 years of being in the Army, I have NEVER gone to Sick Call.  Never, never, never.  And I wasn't going to start now.  Sure, my foot and ankle hurt, but I have twisted my ankle, stubbed a toe and wrenched my knees plenty of times.  Rest, Ice, Compression, and Elevate.  Anti-Inflammatory meds were consumed. 

I had things to do!  Our trip to Florida was coming, we had a son going off to college for the first time.  Busy!  I promised my wife, friends and co-workers I would get my foot checked out upon our return.

As the swelling and pain subsided in my ankle, I did notice that swelling and pain in my foot and big toe did not.  I knew that something was not right in the two joints.

Doctor's Appointment

So, I did not go to SICK CALL.  I made an appointment with my doctor for September 7th, 2017.  He took some X-Rays, and after reviewing them, he said "...you have been walking around your foot for how long?"

04 May 2017

Delta Agent Lied to Us!

Most of us value Trust and Integrity.  A long-time friend of mine would say "Trust is never an issue until it is broken".  Very true statement. 

Over the past few months we have seen a battle between the Airline Industry and Customer Service.  This post is not about who is right or wrong, there is plenty between both parties, and neither side is truly innocent.  (Don't look for trouble and start flailing- United.  When told to leave your stroller in the jet-bridge, don't ignore then cause a scene on the plane-American.)

However, a recent event we experienced with Delta was not at that level of 'YouTube' streaming, it was an experience in poor customer service and integrity.

Bottom Line- Delta Agents lied when they said we could rebook our flight because our Delta Flight was cancelled to mechanical problems.  We could not wait until the next evening for the next Delta flight as we had minor-children waiting for us at the destination.

When I called to find out the process for reimbursement, I was told by a Delta Agent that "I was incorrect, that we were not entitled to reimbursement."  After several phone calls and continued pushback from Delta staff, they basically offered us a 'bone' to go away.  We paid over $1,050 to fly home, and Delta offered us a total of $900 in gift cards. 

Airlines do not seem to want to truly accept responsibility for what their employees say and do. 
Airlines are willing to accept this risk knowing that the public has few options when flying.
Airlines will 'apologize for the inconvenience', while knowing full-well there is no value behind it.

We were lied to by Delta.  I am just not sure from which of Delta's mouth we were lied from.  Trust is never an issue until it broken.  Unfortunately, I must fly Delta on occasion due to my job.  However, when I have choice, I will choose another airline if at all possible.  

Delta has lost my trust, and will take a long time to recover. 

P.S.  Below are messages between me and Delta Staff regarding our situation.  I continue to be amazed at the lack of Delta's willingness to accept responsibility.  We were only asking for an additional $145.79 more to cover the total cost of the flights to return home, as we were promised by the Delta Agent.  So much for Delta's CEO Edward Bastain's  commitment to customer service and integrity.


Mr. Bastain,
Due to the recent publicity of major airlines staff and paying customers, I am resending a previous e-mail I sent to you and the Customer Service Staff.  Unfortunately, I assume this is being filtered by staff and not personally read by MR. Bastain.  Although my case presented below is technically 'closed', I continue to be amazed as what was allowed to pass without acknowledgment of any wrong-doing on part of Delta.  As you are aware, an event recently happened where Delta staff were no aware of the law and threatened with arrest. 
Your staff, as mentioned below, lied to me and my family by stating we would be reimbursed for costs associated with multiple mechanical problems with our flight.  We did receive 'gift cards' from Delta and a refund of our Skymiles (because we were force to return home on another airline).  Yet, I was basically told I was wrong in 'assuming' we would be reimbursed.  I was lied to by Delta staff that my case was 'escalated' with no resolution.  I was lied to by Delta staff that there was 'nothing more Delta could do'. 
I am stunned that Delta Staff would refuse to honor their word.  I noted above, I am not expecting anything in return, as I received a 'small token' by Delta for the 'inconvenience'.  Service recovery is significantly more expensive for an organization than doing what is right in the first place.  I am sure you and your fellow CEOs of United and American are highly aware of this cost.  
As an active duty Army Soldier, I travel extensively and when permitted I attempt to travel Delta.  Honesty and Integrity are two major cornerstones of the Army Officer, as it is in any other high-reliable organization.  When I am confronted with a situation where I am personally lied to and realize it was for the sole purpose of expedience by the other party that I have trusted for years, it is truly unfortunate. 
Drew Winslow

-----Original Message-----
From: Contact Delta <ContactUs.Delta@delta.com>
To: plymouthrock1969 <plymouthrock1969@aol.com>; edward.bastian <edward.bastian@delta.com>
Sent: Wed, Dec 14, 2016 2:49 pm
Subject: Re: Dishonesty and Leadership (Case # 21829163/18201288) (KMM66643106V48519L0KM)

Hello Andrew,
RE: Case Number 21829163
Thank you for your latest correspondence. I understand our Delta representative mislead you on the types of reimbursement we cover. I realize you are upset with not getting to your destination as planned.
I have gone over this experience again and I am sad we aren’t able to resolve this matter to your satisfaction. We would have much preferred to please you, and I’m sorry.
We do appreciate your persistence but we will have to agree that we cannot find the right solution this time.
Drew, we value and appreciate your loyalty with Delta.
Mateo F. Ricks
Original Message Follows: ------------------------
Dear Mr. Bastain,
As a long-time loyal Delta Customer, it disappoints me that I must send this message to you personally.  My desire for compensation is small in scope, but it is the underlying lack of empowerment and willingness to blame other is what concerns me.  Over the years, my employer requires me to fly the least expensive airline between destinations, and if I choose another airline, then I pay the difference.  I almost always will pay the extra to fly Delta.  Unfortunately, the recent events may result in a change in this.
Sadly, this all started when our outbound flight (SAT-IND, 10NOV2016, DL4603) was delayed in SAT due to mechanical problems with the aircraft, which caused us to miss our connection in ATL, but were rebooked and arrived approximately three hours later.  Then upon return flight our departing flight from IND (IND-SAT, 14NOV2016, DL1411) again was delayed due to mechanical problems with the aircraft and were delayed resulting us in missing our connection in ATL to SAT.  We had minor children waiting for us at our destination (SAT).  We were offered a return flight on Monday which we did not agree to, and the Reservation Agent (Sue) attempted to make it right.  I was able to secure three seats on another airline to get us home, and gave this information to 'Sue'- who attempted to book those seats, but was unable to do so.  She then told us, based on our situation with minor children waiting at home, to purchase the tickets and call the Corporate Customer Care number and we would receive reimbursement. 
If Delta desires to be a "High Reliable Organization" in customer service, then Sue understands that how to accomplish this task, even though others in the Delta organization do not.  She realized it may cost Delta a little more actual money off the bottom line ($1,045.79) up front, but in the end would go a long way in service recovery for Delta Customers that are already dissatisfied due to Delta's inability to maintain their aircraft.  Perception is reality.  Sadly, all I was told was that agent (Sue) would be retrained and her incorrect information would addressed. 
Unfortunately, Delta has chosen another route of delay, defer, and deny responsibility.  All I hear from Delta is the same rote 'we apologize for the inconvenience, but we don't reimburse or pay for these types of expenses.  There is nothing more we can do.'  Delta has refunded that portion of our tickets.  Delta has offered us three $300 gift cards.  Those do go a long way, but unfortunately, I had to fight and argue and 'educate' Delta Customer Representative on Rule 240 to even receive the gift cards.  In the end we are still paying for the airfare that we were promised Delta would reimburse. 
Initially, my reaction was that the initial agent lied to us about Delta reimbursing us.  Now, I believe she was the employee who knew what Delta Customer Service is, yet those in the Corporate Customer Care who may need training in service recovery. 
Drew Winslow
DL FF 2179359316
Bottom line- We simply desire compensation of $145.79.  This is based on our purchase of three tickets to get to our destination (ATL-SAT) on another airline after Delta was unable to meet their obligation - $1,045.79.  Delta, after consuming much of my time and Delta Customer Service Representative's hesitation and initial refusal, offered three $300 gift cards totaling $900.  Therefore, $145.79 will compensate us in accordance with what we should have received had Delta abided by the Contract of Carriage and what we were told the Delta Reservation Agent in ATL initially.
Because Delta Airlines inability to maintain their aircraft, My family was delayed over 12 hours in reaching our destination.  Furthermore, if we had accepted Delta's recommended offer of another flight the next day, we would have been delayed 24 hours, cost Delta at least $300 in hotel bills and other ancillary costs in accordance with the Contract of Carriage.  This does not account for our family having to make arrangements for our two minor children who were waiting for us at our destination. 
After further reviewing my case, and based on Delta Airlines Contract of Carriage, rule 240, Delta (sole discretion) had the responsibility to arrange travel for my family (if acceptable) on another carrier.  Delta was either unable or unwilling to meet their legal obligation to help us reach our destination at the earliest possible time on "another carrier". 
It appears that the initial agent (Sue) who told us to go ahead and book our flight on the other flight and that Delta would reimburse us was in the right.  She was up front and honest in telling us that she (Delta) was not able to book that specific flight, but knew what Delta's responsibility was to get us home as close to our initial arrival as possible without impacting our minor children as possible.  Based on the facts as we now know them, it is the 'higher ups' that are now being dishonest in blaming a 'lower level' employee for not telling us the truth.  Unfortunately, weak leaders will always blame someone else in circumstances such as this instead of making a situation right.
Delta’s Liability in the Event of Schedule Changes, Delays and Flight Cancellations
In the event of flight cancellation, diversion, delays of greater than 90 minutes, or delays that Delta Domestic
will cause a passenger to miss connections, Delta will (at passenger’s request) cancel the
remaining ticket and refund the unused portion of the ticket and unused ancillary fees in the
original form of payment in accordance with Rule 260 of these conditions of carriage. If the
passenger does not request a refund and cancellation of the ticket, Delta will transport the
passenger to the destination on Delta’s next flight on which seats are available in the class
of service originally purchased. At Delta’s sole discretion and if acceptable to the passenger,
Delta may arrange for the passenger to travel on another carrier or via ground
transportation. If acceptable to the passenger, Delta will provide transportation in a lower
class of service, in which case the passenger may be entitled to a partial refund. If space on
the next available flight is available only in a higher class of service than purchased, Delta
will transport the passenger on the flight, although Delta reserves the right to upgrade other
passengers on the flight according to its upgrade priority policy to make space in the class of service originally purchased
Drew Winslow, LTC, MS
Army Reserve Personnel Proponent Officer
Fort Sam Houston, Texas 78244
-----Original Message-----
From: Contact Delta <ContactUs.Delta@delta.com>
To: plymouthrock1969 <plymouthrock1969@aol.com>
Sent: Tue, Dec 13, 2016 6:06 pm
Subject: Re: CC-Voice a Complaint-After Trip (KMM66614991V73747L0KM)

Hello Andrew,
RE: Case Number 21829163
Thanks for contacting us again. I’m happy to help with your escalation request regarding the Contract of Carriage agreement and compensation for your out of pocket expenses.
I've tried calling you again but was unable to reach you therefore I left a voicemail.
However, we do not cover for expensive such as childcare, food and flown plane tickets.
Feeling like you were heard is so important to us and I am sorry you feel otherwise. I've tried to see this from your point of view and respectfully, there’s nothing more for me to do. I’m sorry to dissatisfy you.
Please be advised that three Delta Choice gift code, from delta@deltachoices.com were authorized already for the amount of $300.
I know you are disappointed but I have gone over this experience again and I am sorry we aren’t able to resolve this matter to your satisfaction. We would have much preferred to please you, and I’m sorry.
Drew, Rachel and Rebekah, we do appreciate your persistence but we will have to agree that we cannot find the right solution this time.
Mateo F. Ricks
Original Message Follows: ------------------------
To whom it may concern,
I received no phone call, nor any message from Delta Airlines.  Once again, the trust between me and Delta Airlines is non-existent.  I was lied to by Delta during this process, and appear to have been deceived again by this message. 
I am forced to escalate this personally as I do not believe anything will be done as it appears that most Delta Employees are not empowered to make any decisions to make a situation right. 
One recommendation is to have Delta Employees read the various Carriage Agreements and compensation policy that I must abide by, but Delta does not.  I am entitled to compensation that Delta refuses to even address.
Drew Winslow
-----Original Message-----
From: Contact Delta <ContactUs.Delta@delta.com>
To: plymouthrock1969 <plymouthrock1969@aol.com>
Sent: Fri, Dec 9, 2016 5:36 pm
Subject: Re: CC-Voice a Complaint-After Trip (KMM65836276V57744L0KM)

Hello Andrew, 
RE: Case Number 21829163 
Thanks for sharing your experience. I've tried calling you again but was unable to reach you. I understand your concerns about the lack of information and not getting to your destination on time. That was not the experience we wanted you to have.
Our goal is to provide consistent and accurate information to our passengers at all times. Thanks for taking the time to let us know that our agent made false statement. I’m really sorry you didn’t get the service you deserved. 
When we receive reports like yours, we forward them to the appropriate leadership team for an internal review. Be assured I will share your experience with our Airport Customer Service and Flight Operations Leadership team in order to make adjustments to improve our service. 
Andrew, Rachel, and Rebekah, we want to give you the best service possible each and every time you travel. It’s our hope that your next trip will help restore your confidence in Delta. We appreciate your loyalty. 
Mateo F. Ricks
Original Message Follows:
Delta Air Lines Customer Care Form
Title: Mr
First Name: Andrew
Middle Name: G
Last Name: Winslow
Reply-To Email Address: plymouthrock1969@aol.com
Airline Program: DL
Frequent Flyer Number: 2179359316
Address: 21111 Malibu Colony
Address Line 2:
City: San Antonio
State/Province: TX
Postal Code/Zip: 78259-2006
Country: US
Telephone Country Code: US
Phone Number: 8434411523
Flight Date: 11/13/2016
Flight Number: DL1411
Origin City: IND
Destination City: SAT
Confirmation Number: F80GGT
Ticket Number: 0062342595064
Class of Travel: main_cabin
Response Required: yes
Message: I am following up from a conversation with a Delta Representative regarding the above DL flight on Sunday, 13NOV2016. This is the details from our recent experience with Delta Airlines, in which we were told was documented in the 'system', however it appears none of this was documented. This leads me to one of two conclusions- we were lied to by Delta that this information was NEVER actually documented, or the Delta 'system' is tremendously lacking that it cannot safely nor effectively capture comments entered into the Delta 'System'. Therefore, my lack of confidence in the Delta 'System', I am attempting to summarize our experience with Delta via this 'system' to ensure this information is captured. When our DL flight was significantly delayed in IND due to mechanical errors, the rebooking agent told us we could make our connection in ATL, which I knew to be ridiculous (20" to get from C to A in ATL) Therefore DL would not rebook us at that time- which resulted in us losing valuable opportunities to get home. After a second delay in IND due to mechanical issues, we finally made it to ATL where we (as expected) found the only DL offer was a flight out on Monday morning. There was NO offer to rebook on another airline. We were tired of hearing from the pilots and other DL statements: "With Atlanta being the busiest airport in the world, Delta has the ability to get you to your destination!" We kept hearing other passengers being rebooked on other airlines (AA, United). That was never offered to me. I kept expressing my urgency of having two minor children in San Antonio waiting for us and that a flight the next day was unacceptable. When I finally called another airline about seats to SAT, I was able to book three seats that were refundable. I contacted DL again and talked with SUE and reviewd our situation AGAIN. I gave her the flight information (AA, 681, three seats) and unfortunately she could not see them in the DL 'system'. She told us because of our situation ((two minor children were waiting for us at our destination) to travel home on those tickets and to call Corporate Customer Care and DL would refund us for the cost of those tickets. "Sue", the Delta Rep I called from a Delta 'Red Phone' on concourse B in ATL stated that she documented all the details about our issues in the 'system'. This morning I called Corporate Care number and talked with [Mary/Cherry?], she was helpful. As most representative do, she expressed regret and apologies. She had NO information in the system and told me that Delta does not reimburse, and that I would need to settle for a $200 gift card to Delta for each ticket ($600). The tickets I purchased were 1045.90. Why would I want a gift card for another Delta flight when this is how we are treated? We missed our connections on our outbound flight and was delayed for over two hours! This who problem stemmed from the DL agent's inability (or refusal) to place us on another carrier's flight when the opportunity was right there. Mary told me that she was only allowed to offer a $200 gift card that could be for a number of retail stores or AMEX. I refused and stated that there must be an higher authority that can discuss this problem and help make it right. As I saw it, Delta lied to me during this entire situation. I was told the information was captured in there system- It was not. I was told Delta was responsible and that due to the urgency of our situation I could book my tickets home and receive reimbursement from Delta- that was not the case. After continued discussion, Mary did some 'research' and came back with a $300 gift card offer, and a refund of our return flight tickets. This was much better, and was concerned by accepting this offer I was giving up my rights as someone who was lied to by Delta, arrived ten hours late and incurred significant costs (plane tickets, food, childcare expenses) due to Delta's refusal to help, yet only offer 'apologizes for the inconvenience'. I accepted this very small offer of $300 for each ticket (leaving me with a debt of $145.79) Unfortunately, when I received the link to activate these cards, there is NO AMEX selection. Only to retail vendors that I am not interested in! Knowing that an airline that I have been loyal to for over 25 years is willing to lie to me, tell me one thing on the phone, then deny it later is extremely disappointing. A company that is willing to refuse to make a situation right for a $145.79 is a company that seeks short-term gains over long-term success. I know that I am only one, but Delta is losing my business. Against my better judgment accepted Delta's offer in good faith that I would receive what was agreed upon. Unfortunately, like several times this weekend, I was deceived. I expect a phone call to discuss this situation and how Delta will make this situation right. Drew Winslow 843-441-1523 plymouthrock1969@aol.com
Submitted: Mon Nov 14 2016 12:15:26 GMT-0600 (Central Standard Time)
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