MRI and leg pain
A week after I was supposed to be called to schedule an MRI, I finally got scheduled and had three studies done of my left leg last night (one of the knee, and two of the calf, one with and one without contrast).

The leg has been feeling better. I'd describe the knee as feeling "weird" more than feeling in pain. The calf is still tender and painful when you poke or press the area with the fluid pocket, but it no longer feels like an intense charley-horse. The skin infection appears to be gone, but my PCP is having me do another 10 days of antibiotics just to be 100% sure, since I don't seem to be having any side effects from them anyway.

The MRI facility has changed since I last had one, about 15 years ago. Then, the machine was in a trailer affixed to the side of the building, now they've built and addition to the hospital and the MRI machine is in the building proper, with it's own little waiting room, changing room, etc. A smaller space, but much better integrated into the hospital. The machine is also smaller as well, with what feels like a much shorter tube and plenty of space on either side of it. Overall, it had a nicer ambiance than before (and we all pride our hospitals on ambiance, right?).

Unfortunately, this MRI trip was much, much more painful than the last one. They have to immobilize the body part they are scanning to get good results, which can be uncomfortable or downright scary to some folks. I have no problem with lying still, as long as I'm comfortable. When they immobilized my head and neck 15 years ago, there was no problem. I was fine. When they immobilized my knee and had me flat on by back for the first test, there was a problem.

15 minutes of being flat on my back without being able to move was painful. The time after that until the end of the test was excruciating. I was listening to music over headphones, so I was coping with "OK, I can deal with this until the end of the song" on a song-by-song basis. Fortunately, I was about a minute into "Freebird" when they said there were just two more images at about 2:30 minutes each and they could let me out. Then it became the rather fun game of "Which will be done first, Freebird or the test?" The test ended first.

After they let me up to walk around a bit, we figured a way to prop my back up so I wasn't flat on my back for the calf studies. I had a wedge under my lower back, and pillows propped up enough to support my head. That was much, much, much more comfortable. However, the immobilizing equipment for the leg and calf was more confining than the knee, and pushed down on my knee joint as well. And the test ran longer, too. As such, while my back wasn't hurting, my leg was in major pain. I've passed kidney stones with less pain. Halfway through the test, I noticed two things: (a) the screen on the front of the MRI machine that I could see had a count-down timer for each image, and (b) the MRI tech would say "two minutes", the machine would kerchunk, kerchunk, buzz-buzz-buzz as they do, and about 20 seconds later the count-down timer would turn on, reading "02:50", counting down. The MRI tech, she lies! But at least I had an idea of how long each imaging would last.

To make matters worse, Pandora stopped about half way through the test, taking the music away from me. The 2nd-to-last song it played was "American Pie", which would have been ironically great for a last song (right before the music died), but alas, there was another.

When the first leg study was done, and they pulled me out of the machine, they wanted to leave me strapped down and give me the contrast injection and stick me back in. If they let me up, they'd have to re-seek landmarks, and it would take longer. If I could just hold out for another 20 minutes... I had them let me up. Bending the knee that had been forced straight (or over-extended) for so long was briefly even more painful, but being able to sit with my hips and knee bent was worth it. While I rested, they did an MRI of someone else rather than keep them waiting. That may have extended my rest, but I'm not complaining.

They didn't stick me in the machine to give me the contrast injection. They worked on that while still imaging the other guy. I got to sit in a comfortable chair while they finally got my vein on the third attempt (after calling in a floor supervisor nurse to do the third attempt, as the MRI techs are only allowed two). So I got to wait as long as possible before they put me back on the rack.

The study with contrast was mercifully fast. They only needed three or four images (each about 3 minutes long), and it didn't take them long to find their way-points for them.

The leg hurts more today than it did yesterday before the tests, so I think I'm still recovering from the trauma.

I have a followup with the orthopedist on Monday.

Update on the leg
In my last post about my leg issues I ended one paragraph with "More when that happens." It's happening! Well, it's on its way to happening.

Since last week, I've been taking antibiotics to fend off any lingering traces of cellulitis. I have about a weeks supply left. It seems to be working well, and I have another 10 days refill available if I and my PCP feel it's necessary. My leg no longer feels warm, inflamed more than usual, nor does poking it hurt very much. The fluid pocket still appears to be there in my calf -- if I poke the right spot, it's still tender, and feels a bit swollen to me -- but it's not the active major pain it was.

Over the past couple of months, the pain in my leg has been moving, as if there are several things going on and I can only feel one of them at a time. First, my knee ached, then hurt. Complaining about the knee pain to my PCP got me an orthopedist referral. Then my calf hurt, and the knee pain seemed to go away. Eventually, I took the calf pain to my PCP's office, and they (unintentionally) sent me to the ER, where they found cellulitis and the fluid pocket. Antibiotics worked to take away the lower calf pain, leaving just the charlie-horse pain from the fluid pocket. Over time, that has faded, unless I prod just the right part on the leg. It is at best an ache now. But when that faded, the pain went back to the joints: left knee, right knee, right hip. For a day or two both knees were hurting bad. I figured the hip was hurting because I was walking funny and stressing it in unfamiliar ways, and the right knee was probably similar -- compensating for the left hurting put the hurts on it, too.

Right now, the left knee feels slightly achy, but a bit weird, with the anticipation that if I do something wrong it could hurt a lot. The right knee and hip are back to their normal pain-free. The left calf is also slightly achy where the fluid pocket is.

Anyway, back to the update.

The orthopedist's office said they needed pre-clearance from my insurance company before they could schedule the MRI, and they'd get back to me when it was scheduled. That was last Monday. On Thursday or so I got a voicemail from my insurance plan. As they won't actually discuss any specifics on a voicemail (for privacy reasons) the message was pretty mysterious. They were calling about my health plan benefit, that it wasn't urgent, and I'd be getting a written notice anyway. I couldn't get a sense of if this was them saying it was approved, or if it was them saying it was not approved. But I didn't hear anything from the orthopedists.

Before I could call them today, they called me. I don't have an MRI scheduled, but I have a pre-MRI medical phone interview scheduled, at which point the MRI will be scheduled -- and then I need to call the orthopedist back to let them know, and to schedule the post-MRI followup. So things are progressing, just not as straight-forward as I'd like.

On a happier note...
As of January 21st, starsplattter and I are a couple. She and I have been friends for a few years, and both of us are heavily involved in the local Makerspace. Both of us have had mutual interest for a couple of years, but for various reasons neither of us acted on it (well, she says she flirted heavily, and I'm blind to flirting, so...). At the beginning of the year, we both took a chance, and found we both really, really like each other. I'm happy with her, and she I.

Breaking up is hard to do
As of last night, skitten and I are no longer a couple. The breakup was relatively amiable and mutual, and we remain friends. Which is good, because like all long-term couples we are entangled in ways which will take a while (years, maybe) to separate. This has been coming for a long time, so the talk we had last night was more saying-what-had-been-unsaid than a fight.

I think in the long run, I'll be happier, but right now there's a certain amount of sadness at the loss, expected as it was.

To Doctors I will go
So Yesterday morning I went to see an orthopedist. My PCP referred me to him about 3 weeks ago, before the most recent blowup of cellulitis and calf pain, because of recurring left knee pain and visible swelling of the knee during my routine 3-month exam.

I can't say I appreciated the orthopedist's bed-side manner. One of the things he dictated into his notes was that the visit took over an hour of doctor time interspersed with waits for imaging, etc, over 50% of which was hands-on examination and discussing the diagnosis with the patient. If dictating his observations and sundry into his report in medical language, talking near me, but not really to me, constitutes "discussing", sure, I'll buy it. He also demonstrated to his MA how to tell the difference between cellulitis and hyperpigmentation due to chronic lymphedema by poking my left leg (which blanched when pressed, then reddened again as the blood reperfused the porous skin tissues) and my right leg (which remained red even when poked). I don't mind using me as a teaching example, but it would have been nice to be asked first.

Other than that, I think he showed a lot of skill. He dictated quickly a lot of findings from his exam into the report, including things I didn't notice him checking (like my gait when walking). There were some things he felt in the knee, including one this that was "positive" and something else which was "marginally positive", but I don't remember the terms he used to list those. He did not adequately tell me what those were or what they meant. I think next time I see him I'll ask if I can get a copy of the report, so I can read it with a medical dictionary/Wikipedia next to me. He did express a concern about the chronic lymphedema in my legs, and suggested that my PCP look into treating it more aggressively and exploring venous insufficiency.

He did get 4 X-Rays of my knees (one of both together, three of just the left, in 3 different angles (front, side, "sunrise"). He also is scheduling an MRI of my left knee and left calf to get a better handle on what might be going on in the knee and calf. The imaging showed that the left knee has some arthritis and also a mild bit of osteoporosis, which is unusual in men of my age.

When I was leaving, he was looking at the CT scans done last week on my calf, and he pulled me aside to show me the fluid pocket (I'll take his word it's there, I couldn't interpret the images well enough to see it), and to say he thought it likely a hematoma caused by a popped vein in my calf, which happens. The MRI will give more info.

I'm supposed to return to him after the MRI, but I currently don't have an MRI appointment. They need to pre-clear it with my insurer first. More info when that happens.

This morning I had an appointment with my PCP, as a follow-up to the ER follow-up appointment last Monday. He thinks my leg is looking much better, but just to be sure he prescribed another 10 days of oral antibiotics, with a refill available if I needed it. I told him about the orthopedist visit (he didn't have the report yet), and he reacted strongly to the osteoporosis indication. I am the wrong gender, wrong age, and wrong weight to get osteoporosis in my legs. He feels if it's really there, we need to find out the cause. He did clear me to walk to work again, if I could do it without to much pain.

I got a ride about half-way to work today, and the remainder of the walk took a lot out of me. One of my co-workers asked me if I was OK, and offered pain-killers if necessary (I said I already had Advil available, but thanks). Walking home is going to be more challenging.

On legs, Hugos, and maybe other sundry stuff.
Since last I posted about my leg, I've been to see the doctor. He basically checked out that the swelling and redness seem to have gone down, gave me some more context on the fluid pocket in my calf, added a potassium supplement to my prescription regimen, and told me to come back in a week, at which point he might renew the antibiotics if they look necessary. I don't have to use the cane if I don't feel like it. It's still handy to have around, though.

I also saw Dr. Sholls diabetic socks in Target. They claim to not have a constricting top, to allow for better airflow, better drying, etc. They were $10/2 pair. I think I'll pick up a pack next time I'm there.

As to the mysterious fluid pocket: According to the radiology/sonogram work, it is either a low-density mass or fluid (both are transparent to X-Rays), and is about 10x7x2cm. I liken that to the side of a deck of cards, but honestly it could be much smaller, as it's likely thinner at the edges, rather than a square block. It is possible that it's a ruptured Baker's cyst which can form behind the knee and when it bursts dumps synovial fluid down the calf. The description on the Wikipedia page of the possible result is very consistent with what I felt.

I will bring this whole issue up with the orthopedist on Monday.

I've been following, mostly via the Making Light blog, the recent kerfuffle regarding the hijacking of the 2015 Hugo Award Nominations. There's a lot that's been written about it, but I'd like to link to Philip Sandifer's essay Guided by the Beauty of Their Weapons, about the personalities behind the "Sad Puppy" and "Rabid Puppy" slates.

I guess there wasn't any other sundry stuff.

Legs, knees, and other pains
For a few weeks/months now, my left leg and knee has been bothering me. It feels like whenever anything goes wrong that'll hurt a leg, it's my left leg that gets it, and that includes slipping and falling on ice during this brutally cold winter. I went to the ER earlier the year where they ruled out blood clots, broken bones, arthritis, etc. They gave me Tramadol and told me to keep it elevated, and follow up with my doctor. The extreme pain resolved itself.

I had a scheduled doctor's appointment two weeks ago, and I brought to his attention the problems I had been having with my knee. Among other things, there was a noticeable swelling difference between left and right knee, although at the time of the appointment it wasn't much. He referred me to an orthopedist, and I have an appointment with him in a week.

But over the past two weeks my calf and leg pain got worse, and I ended up using a cane a lot just to walk -- although I did find that walking on it felt like it was stretching it out and making it more bearable. I tried calling my doctor on Thursday to set up an appointment to see him about it sooner than otherwise, but I called too late, after the office had closed. Calling again on Saturday got me a 10:30am appointment to see a Nurse Practitioner.

My 10:30 appointment got me recommendations to keep it elevated, take pain meds, apply warm compresses, etc -- and to go to the hospital to get a doppler ultrasound to rule out DVT.

At the hospital, we checked in with admissions for the ultrasound, and after 5 minutes in the waiting room, the admissions clerk came in and apologised: she can't book me for an ultrasound on the weekends, only the ER can do that.

So we trundled to the ER, expecting the ER admissions clerk to do what the regular admissions clerk could not do. Instead, I was given the full ER treatment: triage, placed in an ER room, visited by ER staff, etc.

The physician's assistant managing my case was fairly certain that I had a skin infection/cellulitis, given that the back of my calf was bright red, tender, and inflamed. She pumped me full of IV fluids, Vancomycin, and Cefalexin (I think), and prescribed me 10 days of two oral antibiotics.

I did get the ultrasound to rule out DVT. No DVT, but there's some mass/lump/pocket of fluid in my calf muscle that they don't know exactly what is. The ultrasound tech mentioned it could be from a ruptured Baker's Cyst, it could be a haematoma. The physician's assistant managing my case in ER was concerned that it could be pus, or possibly an abcess that needed to be drained. I got a CT scan to help figure out what it was. They ruled out a drainable abcess, but did not (to me at least) clearly identify what the fluid was. They want me to follow up and keep an eye on the situation.

Overall, I spent about 7 hours in the ER for what was supposed to be a simple diagnostic test ordered by an outside doctor.

But something seems to have worked. Sunday morning my leg was looking much better, and I can walk with only a small amount of pain now. I am in danger of leaving my cane behind by accident when I do use it.

I have a follow-up appointment with my PCP this afternoon, as per ER instructions.

Assassin's Creed
I've been playing a lot of Assassin's Creed lately. A friend showed me the game (AC2, for those keeping track) on Christmas Eve, and I've been playing it since. I'm most of the way through it, and I expect to get future Assassin's Creed games once I finish this one.

It occurred to me yesterday that when I talk to people about it, and where I am, it's always at some hard or problematic part of the game. That's not because the game is generally hard or problematic, but that's where I get stuck, and put the game down to do other things. So of course when I see people and wax on about the game, it's at some place where it's hard or problematic. (And, of course, as if to test this rule, the game is currently paused at home right before what I think will be a very easy mission because after being stuck in one room in the game all day yesterday, I finally completed the puzzle this morning, but didn't feel I had time to do the next mission before work.)

I've some thoughts on playing this game:

  • Video games are cheap entertainment. I spent $20 on the game, $20 on a controller, and I'm using a pre-existing computer and TV setup. According to Steam, I've played 298 hours so far, which is probably wrong, as that's roughly half the time since I bought the game. Let's say 40 hours over the past month. That's $1/hr of entertainment, and falling. Compare that to a movie in a theater, a book (I can read a $9 book in 2 hours), a good meal, and it's cheap.

  • Modern AAA video games can be gorgeous. AC2 is beautifully rendered and detailed, even though it's 5 years old. It's a pleasure to watch.

  • I like the fact that the game can go at my pace (mostly), and is not generally a twitch-based game. I do poorly in games where I am under severe time pressure, even if it's something like "OK, I see my target, aim, fi---I'm dead, who shot me?". I like that I can walk across town, and not have to run across the rooftops, although that can be fun, too.

  • The Assassin's Creed games mix history with fiction. This game features real aspects of the rennaisance (like the Pazzi Conspiracy, Marco Barbarigo's reign as Venetian Doge, Leonardo da Vinci) with fictional aspects (the underground war between the Assassins and the Templars, the other Barbarigos, etc). As such, the feel of the game is good, but it shouldn't replace a history text. It may get you to read a history text, which would be good.

I intend to get other games in this series when I finish this one, which should be in another 150 hours of game-play (or maybe 20, who knows?). It's fun.

Answer for question 4174.
If you won the lottery, what three things would you buy first? Would you give any to charity? Would you take the money all at once or get it in installments?
If I won the lottery, I suppose the first thing I would do would be (retroactively) buy a lottery ticket, since I don't buy them.

But assuming that I won based off of a ticket that was given to me, or found by me, or otherwise came into my possession legitimately despite my not being a purchaser of such things...

First things first would be clearing debts, so that would effectively mean paying for the car I currently own, the house I currently live in, and the college education I got lo those many years ago. That's three things. Then I would buy a new roof for the house, which it needs.

However, probably first, before all that, would be a celebratory dinner.

Having a large pool of money would mean that some of it would probably go to charities, but not a substantial amount.

I would probably take the money in a lump sum. The ways these typically work is that they will say "you won $1M. You can have it as $600K today, or divided into $50K/year for 20 years." What that means in practice is that they can buy an annuity that will pay the $50K/year for 20 years for $600K, so they will offer you the choice of how they spend that $600K. Unless my winnings are large enough that the annual payout can actually pay for the car/house/college, it would probably make more sense for me to take the lump sum, then buy an annuity myself with the remainder. Given that car+house+college+roof would be under $100K for me, it may make sense to go with the annuity if I were to win over $3M in the lottery.

NaNoWriMo Day 1
1789 words.


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