Getting A Little Work Done

A girl I briefly dated once told me I had, "No ass." As it turns out, the location of my oft-discussed pressure sore as evidence, I suppose she was right about that. After tomorrow though, in that spot, I will have less. And as a means to an end this will be a good thing.

Hey Hey, My MRI

This is how the pressure sore looked in September of last year. In this cross-sectional image, my legs projecting out towards the viewer, the sore is circled.

The next image is the condition of my sore in April of this year. Not much difference in the appearance, hence the necessity of the third surgery to clear out the last residual infection.

Over the summer I underwent daily hyperbaric oxygen treatments to help aid in healing this sore (and in conjunction watched a lot of shitty movies - I'm looking at you Mission: Impossible 3). While I can't confirm the extent to which these hyperbaric treatments contributed to curing the osteomyelitis that delayed the healing process for these many months, the wound responded to treatment in such a way this summer that the U of M plastic surgery team feels they can safely close my sore with a flap procedure.

Everyone's Favorite Substitute Anatomy Diagram, One More Time

A pressure sore forms because the blood circulation to the tissue covering a bony prominence becomes constricted and the tissue then deteriorates. When it was discussed with me last October that these sores often need to be closed surgically and that this was often accomplished with a flap procedure I was under the assumption this would be something similar to a face lift. An ass lift of sorts. I'm not going to pretend to know all what is involved in a face lift, but I do know that it entails stretching loose skin back to make it appear tighter, more youthful. Simply stretching the skin next to and over the cavity caused by the pressure sore will not rectify the problem of providing more cushioning over the ischial bone where the sore formed in the first place ("No ass," as stated previously). The gluteal rotation flap attempts to solve this problem by moving not only the skin but a portion of the gluteus maximus muscle over the depression caused by the sore. The procedure is more involved than the three debridements and biopsies that were previously performed and is expected to take two to three hours. I'm anticipating to end up with a scar that looks something like this:

(click to enlarge)

The convalescence period after this operation starts with at least three weeks of complete bed rest to allow the flap to take hold. After which point, if the drainage has subsided, I can start a sitting protocol regimen. I will begin with fifteen minutes of sitting three times a day. If there are no problems with bruising or lack of circulation, the sitting durations will be increased by fifteen minutes every couple of days. If all goes according to schedule it will be a six week recovery process.

And then I'll finally be able to get back to whatever it was I was planning to do last fall.

There Is A Light...

...at the end of the tunnel. The light is but a flicker, but it is there. I found out today that there is hope for a conclusion to the saga of the pressure sore coming in the form of a plastic surgery procedure. Finally.

The procedure is scheduled for September 17th. Why almost a whole month from now? Why not sooner? Because any sooner would be, well, convenient. And the U of M Plastic Surgery department isn't in the convenience business, they're in the Michigan Difference business! Or so I've been told.

Post surgery convalescence will be a stay of three to five days in the hospital followed by a scant six weeks of total bed rest. Wait, an additional six weeks? C'mon, what's six more weeks of lying around when you've already logged over fifty? I mean besides "the rest of September" and "October."

I suppose there is a chance this sore could heal on its own in the intervening month and I wouldn't need to have the surgery, but that would be way too...um?...ahh, what's the word?

Anyway, so there's a light somewhere down at the end of the tunnel.

I just hope it isn't a train.

That would suck.

Suck On That. Suck It Long, Suck It Har...at 80 mmHg

Time for something different. When I learned in March that I would need a third debridement and ischium biopsy peformed on my pressure sore, with the prospect of losing an entire summer on the couch, I wanted to know if there was a better way to end this predicament. Much to my frustration, my doctors at UM Plastic Surgery were more than satisfied with the way they felt my wound care had progressed. Yes there have been setbacks, but the problem up to this point has been a lingering myelitis bone infection deep in the wound that prevents the regrowth of tissue over the biopsied area of the ischium. If the wound doesn't heal from the inside out, it will never heal properly. In the view of my doctors at UM, they have pared down the area of infected bone and with this third ischiectomy and another course of IV antibiotics, they are confident this sore will finally heal as is it supposed to. When questioned whether or not there was anything I could do in addition to what we've already done, the answer was, “No, not really.” While they might be right in assuming that if they finally kill off the infection the wound will heal from the inside out and no further debridements will be necessary, they've also be wrong twice so far and I've lost eight months to this sore. I decided to look for other options. I'm now entrusting my wound care to the Wound Healing and Hyperbaric Center in Westland, MI, an extension of Garden City Hospital. My main reason for selecting the Wound Healing and Hyperbaric Center was the availability of hyperbaric oxygen treatment which is supposed to provide excellent support in healing all sorts of chronic wounds (more on that later). This is a therapy not offered by UM. An additional reason influencing the decision to work with the wound specialists in Westland is their willingness to try other wound treatment options. At UM, the extent of the suggested wound care regimen was twice-daily wet-to-dry dressing changes and after a course of antibiotic treatments application of the growth factor medication Regranex. Again, other treatment options were not suggested or recommended. At Westland, during my initial consultation, several treatment options that had been suggested to me by visiting home health nurses I've spoken to, but not favored by the doctors at UM Plastic Surgery, were discussed from the outset. One of those treatments is negative pressure therapy, also know as a wound vac. Negative pressure therapy uses suction to enhance the capacity of the wound to heal. The suction increases blood flow to the wound bed similar to the telltale signs of a junior high, hickey-inducing makeout session. The increased circulation brings much needed oxygen to the tissue critical to wound repair. In addition, the suction removes harmful waste drainage away from the wound site. With the waste drainage removed and increased blood flow to the wound bed the formation of granulation tissue is enhanced. The granulation tissue is the base layer on which skin cells can form. After increasing circulation and removing the excess fluid, there is also a diminished opportunity for harmful bacteria to take root in the wound. All of these characteristics of negative pressure therapy are encouraging when compared to the alternative of what I've been doing. Some of the research suggests that negative pressure therapy doesn't necessarily speed up the healing process, and I will have to carry around a small vacuum unit with conspicuous tubing running from my wound and out of the waistband of my pants. Even if the speed of the healing with he wound vac is negligible compared to more traditional methods, at this point it is worth a try.

Didn't See That One Coming

When your dementia-addled hospital roommate shits on the floor because he'd rather not shit the bed, and then forgets to signal the nurse call light because of said dementia, well, that's an odor that lingers. I suppose I can't blame the guy, such are acts of self-preservation when faced with limited options. All day since I've been experiencing phantom whiffs of the experience; an unpleasant reminder of my two-and-half days at University of Michigan Hospital following my third pressure sore debridement surgery. I had already made up my mind that I was ready to go home the night before and was informed I was to be discharged earlier in the morning, but crazy-old-guy-losing-bowel-control is a moment that really drives home the desire to get the F out of Dodge. I'd also like to have this whole on-going ordeal come to a conclusion before...why even speculate?

The truly sad thing about the old guy is that in his brief moments of clarity he had been trying to convince various hospital staff members (and more likely himself) that he was ready to go home on his own instead of into a home for "rehab"--as his discharge planner so delicately put it. From my point of observation it was easy to see that none of these people believed going home was an option the old coot would get to explore. Shitting on the floor was more than enough nails to seal that coffin.

Today's lesson: Stay fit people and keep the mind sharp.

WTF? You're Still Here?: Familiarity Breeds Contempt

There was a time when things pressure sore were a lot easier to lampoon, but that ship is loaded for bear and untied from its moorings. The wind is blowing like stink and she's about to set sail. We had our fun I guess: this handy visual aide comes to mind. But that was back in the halcyon, autumnal days of aught-seven, when this sore was just a ragged, odorous, weeping, infected mess. I took the professional advice and followed the proper course of action. A corrective procedure here; a ten week course of antibiotics there; the New Year held promise of good tidings, but 'twas not to be. "We're very, very close. I can feel it." Give it a second go-round and we'll nip this thing in the bud. What's six more weeks, anyway? That was January. Yeah...Not so much. It's like this: They really should have stopped after Police Academy 2. Let's see: Mahoney is the comedian, Hightower is tall and strong, Tackleberry loves guns and Jones tricks people with sound effects. Oh, and Callahan has huge Js, but you never really get to see them. We get it! Guttenberg even called it quits after Four and yet they still kept plugging along. But what other ideas are there? And so back into the breech... So, No, Cube, even though I did not have to use my AK, today was most definitely not a good day.

Doctor's Day 2008. Who Knew?

So yeah, I guess tomorrow, March 30th, according to the University of Michigan Health System, is National Doctor's Day. And I guess the University of Michigan Department of Internal Medicine felt I should be aware of this because, well I don't know, maybe because I tend to spend a lot of time hanging out at the hospital. When I opened the promotional materials sent to me making me aware of Doctor's Day, I immediately asked myself, "How can I best join in recognizing the splendid efforts of the fine physicians at U-M on Doctor's Day?" The answer is simple. I can "Make a Difference Through a Unique Tribute" of a tax-deductible donation, as recommended in the enclosed fundraising form. The Department of Internal Medicine has conveniently chosen a few monetary levels at which I can express my gratitude: $50, $100, $500 or "Other."

Now, in the last few years, I have learned a few things about hospitals, insurance coverage, medical billing and the like, so I know that even though patient medical bills seem to be exorbitant hospitals still need to budget their resources and a little extra cash in the coffers always helps. But, milking me in the name of doctor appreciation, well, that strikes me as a bit disingenuous.

I am made aware that I can make my donation in the name of my favorite U-M Internal Medicine specialist. Oh, how nice, but I have so many more questions. Is my chosen doctor going to get a cut? Is there a tote board in the break room keeping a running total raised by each doctor? "Jim, your patients are really sending in the scratch. Keep up the good work." How will I choose which Internal Medicine doctor to recognize? The last time I was at the hospital for a stay, I saw eight different Internal Medicine doctors, and that's not counting the two Plastic Surgery residents or medical students who came in my room to poke around. For reals, Yo. Eight. Plus, I would like to think that my favorite Internal Medicine doctor is already aware of my satisfaction with their care. A showy, unnecessary display of gratitude on my part would just embarrass them; s/he isn't big on P.D.A. (I'm playing the pronoun game so as not to hurt the feelings of the other seven). And cash donations are so cold and impersonal. It's like giving a gift card at Christmas: "I like you, but not to the extent to know you well enough to buy you anything specific." How about if we all just sign one of those oversized Thank You cards? No?

So here's my thing: If I do send some greenbacks your way U-M, can you guys get cracking on figuring out a more effective method of encouraging tissue growth around my wounded ass bone? I'm not complaining and I'm definitely not a doctor, but it just seems the traditional method of lie-around-and-wait-and-see is really time-intensive. I'm just asking because I had a couple things I wanted to do this...7 months ago.

The Michigan Difference

The last few years, the university has touted "The Michigan Difference" as their main message in all of their advertising and so all of the publicity media have the same general look. The Health System advertising is the most prominent: atmospheric, instrumental version of the Michigan fight song playing in the background, shots of diverse doctors and nurses at work, a montage of patients with horrific scars overcoming adversity, someone doing science, someone writing something important on glass, a voice-over extolling how awesome it all is, ends with "The Michigan Difference." The Doctor's Day materials are no different and are of the highest quality. It's a presentation that subtly says, "We're not cutting corners on this, and you're going to give us a lot of money." Their print shop uses great card stock, it even smells professional. I read the spiel about Doctor's Day 2008 and looking back over the front of the donation form--an assemblage of images of U-M doctors in varied types of work--something caught my eye. The doctor in the middle of the frame is holding a Foley catheter. And. He. Looks. Mesmerized.

Um, Why?

"Hey Bob, we're putting together the promo for Doctor's Day 2008 and were wondering if you'd like to be in the photo collage on the front of the fundraising form?"

"What's Doctor's Day? Never heard of it."

"Just this thing the hospital is doing to raise money."

"Yeah?"

"Yeah."

"And why me?"

"Oh, we heard you're doing some really some cool stuff with your research and the Department wants to showcase you."

"Wow. That's really nice. What do you need me to do?"

"Just hold this out in front of you like so...and sort of look towards it and not at the camera."

"This?"

"Yep."

"...But this is a catheter."

"Yeah, I know. Try to look at it with interest--"

"My research is in nanotechnology and--"

"I know and we're real proud of what you're doing...Now really focus your gaze."

"But this is a catheter."

"Yes, but nanotechnology is hard to photograph and get you in the picture."

"What if I look up from a microscope or something?"

"We already did that."

"We did?"

"Just hold it up a little higher, but don't look so much at me."

"Can I hold something like a--"

"Like what, Bob?"

"How 'bout an artificial heart?"

"That's been done too."

"By who?"

"Uh, that kind of goofy looking guy."

"Ted?"

"Yeah, him. And he's Surgery anyway, and this is for Internal Medicine--"

"Well, I'm not a Urologist!"

"Well I know that, but come on. This fits our theme."

"How does this fit our theme?"

"I don't know, 'Our doctor's are passionate about medcine, even the mundane things'."

"When's the last time anyone saw a doctor place a catheter?!"

"I don't know--"

"Can't you just take my picture?"

"You have to be doing something."

"Seriously?"

"Look, I still need to get a shot of Johnson and some old lady before lunch."

"But this is a catheter!"

"Dude. Do you want to be in the picture or not?"

"...I guess."

"Good. Now try to look really interested in the cathe--...You're still looking into the camera, Bob."

Do Not Taunt Happy Serratia marcescens*

Does this bacterial culture look like trouble?

How about now?**

If a person is already mainlining copious amounts of antibiotic medication and they happen to get the former in to their bloodstream, it will start posturing like the latter. At least that is what happened to me a few weeks ago. With an immune system already suppressed by several weeks of antibiotic treatment, the body doesn't take well antibiotic-resistant micro-organisms. My new friend Serratia marcescens fit that bill. My body's reaction was a persistent two-day fever that peaked at 102.7 degrees Fahrenheit. That was enough for mom to shuttle me off to the Emergency Room and another three-day stay at the hospital. The length of the stay was determined by the length of time it took to culture and identify the bacteria that grew out of several samples of my blood. The hot zone in this instance turned out to be the PICC line in my left arm that was placed to dose the IV antibiotics that were supposed to get me healthy after my most recent surgery. Somewhere in the two and a half weeks after the surgery, the bacteria got into the line and reared its ugly head. Treatment of the fever consisted of knocking back the occasional Tylenol, and alternating between a cold washcloth on the forehead and shivering through fever chills; treating the infection consisted of ten-days worth of a couple different oral antibiotics to kill off Mr. Graham-negative stain, as S. marcescens is sometimes known.

For me, going to the hospital is becoming such old hat that I'm starting to not care what the diagnoses are anymore, and mostly just focused on when they will let me go home. It becomes a dance of how can I answer these doctors' questions so that I'm properly diagnosed, but yet don't set off too many alarm bells that will keep me here more than a day? It's the same type of attitude that keeps me from seeking medical attention in the first place and that will probably be my ultimate downfall:
“Tell me sir, how did you get your legs cut off?”
“Uh, I think I was hit by a train.”
“And when exactly did this happen?”
“I think it was Tuesday?...Monday or Tuesday.”
“Tuesday! You realize today is Friday?!”
“Um yeah. Well, you know, 'Lost' was on last night and it was a new episode and I wanted to see it on a big TV.”
“You've lost an insane amount of blood.”
“Well, I can't really feel it, so I figured...”

In summation, a week after I left the hospital I saw my infectious disease doctor and he decided to have me finish out the course of medication I was on when I left the hospital and then to stay off of any further antibiotics. The good news was the bone biopsy that was done in January didn't reveal any further bone infection and the wound site of my pressure sore seems to be healing up properly this time around.

*I was all set to recount this episode but then the day after I left the hospital I found out Deep Purple was playing a command performance at the Kremlin and then things got a little crazy around here.

**The amount of time I spent in MS Paint trying to get this image to look just right probably far outweighs the amusement value of the intended sight gag.

Deja Vu All Over Again

Four years ago today, I broke my neck and ended up in the hospital for 3 months. Today I came home from the hospital after having surgery.

Coincidence?

No, not at all. In fact, considering the 1461 intervening days, the two things probably couldn't be more connected.

I'd like to have this not become a habit.

Been There, Done That

I'm heading back into University of Michigan Hospital tomorrow (Wednesday 1/16) for another surgery in an attempt to get the pressure sore I've been dealing with these last five months to heal properly. Those who've been following along are already aware that the procedure I'm undergoing tomorrow will be a repeat of the one I had back in October. Although highly less than ideal, as I was anticipating as recently as December that at this point in time the wound would be ready to be closed. Upon closer examination, my surgeon determined that the underlying bone might still contain some residual myelitis infection. Thus, he will be opening the sore back up and performing another bone biopsy. This procedure and the subsequent healing period will be a setback of at least another six weeks of convalescence. Thanks to everyone who has and continue to send words of encouragement.

Lather, Rinse, and...Repeat.

SONOFABITCH!
That was the sound my brain made. My brain made that sound because Dr. Rees, the plastic surgeon overseeing the continuing care of my pressure sore had just ended a sentence with the phrase, “debride it again.” This was in direct contradiction to what his physician assistant. Mr. De-Hong, had concluded not three minutes earlier before stepping out of the exam room. The exam room that I was in, side-lying on an exam table with my left ass check exposed. Three minutes prior, my brain wasn't making all sorts of ruckus trashing the joint because, at that point in time, Mr. De-Hong had finished telling me what I wanted to hear. That conversation went pretty much as follows:

De-Hong: Hello Dan, how are you?

Me: Pretty good.
De-Hong: Has your pressure sore gotten any better?
Me: I think so. It's definitely gotten a lot smaller in the last month.
De-Hong: Let me take a look. [Exams the sore] Yes, this is much better. I think we can can schedule the flap surgery, now. Let me consult wish Dr. Rees.

Dr. Rees entered the room and examined the state of the wound. His concern was that, although the wound has filled in quite well and has stayed clean, by poking around in it with his finger, he was able to determine that there isn't yet sufficient tissue growth over the bone that was exposed by surgery to debride the sore back in October. In addition, he could feel that there was still some residual infection in that bone. My mother asked how he could determine that about the bone simply by touch; did it feel “squishy?” He responded that, “Yes. I guess that is a good word for it.”

We asked several more questions about the time table from this point forward. I confirmed what I thought I was hearing, that they would be opening the wound back up, cleaning out the remaining damaged bone and starting me back on another six week course of IV antibiotics. At which point in time, then they would be able to go ahead with the flap surgery to close the wound completely. That all sounded to me like the past two months and ten days of lying around doing Jack had gotten me all of right back to where I already had been. I stated how frustrated that I've been dealing with this since August and now this seems like a step in the wrong direction. Dr. Rees countered with something about how if they attempted to close the wound now there was a fifty percent chance it would break down into a sore again and then we'd be starting all over from square one. Despite the fact that he went on to talk about how debriding the wound now would allow them to close it in six weeks, I had already heard all I needed to know. Plus, it was hard to concentrate on Dr. Rees with the din, blue streak of obscenities my brain continued spewing. At the end of his remarks, I was able to focus long enough to hear Dr. Rees conclude his remarks about pressure sores with, “You have no idea.” As in, “You have how bad these sores can get,” and, “You have no idea how long they can take to heal.”

Well, far be it for me to dispute his medical expertise, but I'm pretty confident at this point that I have an idea. In fact, I think I have an excellent idea. Sure, he sees these things every day and therefor has an excellent gage on what constitutes the varying levels of just how severe these sores can be. And yes, my sore pales in comparison to people that lose toes and legs because of severe complications. But when he starts throwing around numbers like “six weeks” as if they're just some drop in the calendar bucket, then I know he can't really comprehend what this is like. I should have asked him, “Do you have any idea how many times Scrubs is televised during the day?* No? I didn't think so. You have no idea because you spend your day doing cool things like seeing patients, performing stomach staples, and generally getting to leave the house. I know the answer because despite reading books, watching movies, surfing the Internet, and doing my best to avoid watching mind-numbing TV, I'm still lying on the couch for upwards of ten hours a day with Shit to do and have been doing so since August. When you casually talk about prescribing another six week course of antibiotics, you may have read about the potential side effects, but do you know that Vancomycin dries my eyeballs out so that my contacts are always blurry and then they wrinkle up and painfully get stuck in the corners of my eyes? No? Of course not.”

But there's really no point in asking those questions because there isn't any better course of action. So, on January 16th –and it's the 16th because that's the next open surgery slot—I will go in to have the same surgery performed that I already had done back in October. I'll get discharged on the 17th, and then it will be the beginning of the next week until the orders come through to start the IV antibiotics. Six weeks from then will be the first week of March. Will I immediately be scheduled for my flap surgery? I doubt it, so I'm going to estimate that happens in the middle of that month. I already know the rehab protocol coming out of that surgery is at least two solid weeks of bed rest before even limited sitting is allowed. Now it's April, barring no setbacks.

'Tis the season.

*On an average weekday, Scrubs is on 8 times, on 3 different networks. In my opinion it really went downhill after about Season 4, just about the time Zach Braff's head got fat. They've been phoning it in for about two years now.

No Payment Due...That's Nice.

The bill for my hospital stay came in the mail sometime last week. I've been through this enough times that I'm no longer surprised at how much medical procedures cost, but I do still find it interesting at how much my insurance is charged for various aspects of my care. Case in point, here is page two of the bill for my pressure sore surgery:

(click to enlarge)

I kind of got a kick out of the fact that there are two different rates for the time spent in surgery. The first 30 minutes are apparently billed at a set amount of $1396, and then each subsequent minute is billed in addition to that. I now know that I was in the operating room for a total of 98 minutes. The additional 68 minutes clocked in at $2108, which by my calculations breaks down to $31 per minute. That initial half-hour, on a per minute basis, comes in at $45 and some change. Damn, I didn't know I was getting a discount.

Well hey, as long as this thing is on sale is there anything else you guys can patch up? I took a broomball stick across the bridge of my nose my freshman year and my nose just hasn't been the same since. It's not that noticeable, I know, but there's a bump there on the right side...No, no my right...that wasn't there before. Can you clean that up? I mean, this is plastic surgery. Right?

The moral of the story is, if you only have half an hour on your schedule to squeeze that next operation in, it's going to cost you more to come back and have them finish up later. Might as well bite the bullet and be late to that next appointment.

If I Could Feel It, It'd Be A Pain In The Ass

At 7:30am tomorrow (Wednesday), or today depending on when you read this, I'm having surgery at UM Hospital on this pressure sore I've been dealing with for the past 6 weeks. The procedure I'm undergoing is to have an infected portion of the ischial tuberosity (consult diagram or local medical student) removed and the tissue around it cleaned up. The bone needs to be removed so the infection doesn't spread through the pelvis. Unfortunately, this surgery won't actually close up the wound, but in fact make it bigger. The wound needs to heal from the inside out, so I'm expecting about six weeks of post-opt antibiotic treatments, continued daily cleaning, packing and dressing of the sore --all while spending as much time off of my ass as possible. Then depending on the state of the wound, a possible second surgery to finally close up the wound. At that point, I will require 24-hour bed rest until the site "gets all better."

I should be at the hospital until Thursday, maybe Friday.

Good bye Fall. Hello Christmas.

Don't click here.

X Marks the Spot

There's an old saying that states, "Opinions are like assholes; everyone has one." I'm in the minority of people that have two. Assholes, not opinions. Well, one asshole, one hole in my ass...I guess it's more of a crater than a hole.

The medical term for the sore is ischial pressure ulcer, grade IV. What makes people in wheelchairs particularly susceptible to getting pressure sores is the fact that paralysis prevents most people from sensing when an injury to the skin occurs. The poor blood circulation in the area caused by continuously being seated accelerates the speed of the tissue breaking down, hinders new tissue growth, and adds to why these types of sores are so difficult to get healed up. The location of my sore has also been extremely problematic in contributing to it's breakdown as well as it's protracted recovery time. The red X on the attractive Moroccan girl in this picture, me captured rudely ogling her cake, is an approximation of where my sore is located, if she were me.







(Click for a better view)

It started as an irritated patch of skin then through a combination insufficient cushioning and the neglect of out-of-sight,-out-of-mind the skin broke down and a sore opened up. For about a week it was a superficial skin abrasion. At the end of two weeks it was about the size of a quarter and I scheduled a doctor appointment. The doctor discovered that some of the tissue inside the sore had started to die and after cleaning it out and giving me instructions on how to dress it, encouraged me to stay off of it as much as possible - not the easiest set of medical advice to follow in my situation. My bad, it turns out, and when I saw the doctor again ten days later, the sore had deteriorated significantly, was now a centimeter deep in one spot and there was more necrotic tissue. A third visit, the next week, showed more deterioration of tissue and the depth of the sore had increased as well. The hope in treating it was to keep it from getting to the point where surgery was necessary to help it heal properly.

Well, to make a long story short, the month of days spent mostly lying on my side so as to not put unnecessary pressure on the sore, multiple wound dressing changes, way too much TV, and no social life helped to decreased the circumference of the sore, but a MRI scan revealed osteomyelitis in the ischial bone underlying the sore. In layman's terms, a bad infection in the bone that, while localized for the time being, if it were to spread further would be real bad. So, in a week and a half I'm scheduled for surgery to remove the infection. That will be followed up by more lying around doing nothing as the sore attempts to heal properly. I'm looking at mid-November by the time I'm back to full steam.

I'm in the wrong business

It's nice to know that in these financially unstable times the UMHS is still finding ways to pay the bills.

Yes, I realize doctors are very busy. Yes, they have mountains of paperwork to complete on all their patients and there are plenty of better things for them to be doing, but $35? It was only a two page form for christsakes. The ultimate irony is that the form in question was a form my insurance company requested in regards to assess the continuance of my disability payments. Somewhere, in some boardroom with a really great view, a bunch of old men in expensive suits are lighting cigars with burning hundred dollar bills and high-fiving.

I couldn't find my pen filled with blood, sweat, and tears, so I wrote, "what a racket" on the memo line of my check.