Ralph Zimmerman's Blog on RealATC.net, A Blog account of leg

amputation above the knee

and subsequent rehab, workers comp issues.

OK on to the leg loss. But first a little background. Had a mild heart attack in 1991 that caused me to quit smoking (cigarettes anyway!). And a mild TIA I think in about 1999. Never had any ongoing problems associated with these two events. I was diagnosed with diabetes type 2 in about 1998 or so. It's been under control and my last hemoglobin a1a test or whatever it is showed me to be 'barely diabetic' according to my doctor. Then I was diagnosed with PAD (peripheral arterial disease) in about 2001. I inherited that from my Mom for sure. In January 2007 my family doctor referred me to a vascular surgeon to take care of my legs. Early test showed advanced PAD and severe loss of blood flow to my right foot. I could have told the doctor that without a test. Anyway the left leg looked pretty good and we had planned more tests on the right side with the outcome expected to be surgery.

As my very best  friend of 25 years, Denver' had a head and neck cancer that marched on, I was far more concerned with him than me so I spaced the vascular doc for a couple of months and reconnected with him in May 2007, just a few weeks before Denver passed away. So, Denver died on June 7, 2007. Two weeks later, on June 21st I had an freak accident while working and what follows is the exact description that I have given everyone of what happened. 'With regards to the accident that led to the loss of my leg – here are the details: It happened at about 12:30 PM on June 21, 2007 on the property of The Boys and Girls Club of The Pikes Peak Region, specifically, the Eleanor Armitt Tutt Unit, located at 1445 S. Chelton Rd., Colorado Springs, CO 80910. They were a frequent customer in the summer but it had been quite awhile since I had delivered there. It was well know by our delivery staff, that large orders were to be delivered through what was really an emergency exit door on the north side of the building. When I arrived, that door was open in expectation of the timed order (placed in advance for delivery at a specific time). I got out of my car and unloaded the three bags of pizzas that contained 5 large pizzas each. I set them on my car, then grabbed two bags with my left had so they were butted up against each other so the pizzas would stay level and then the third bag in my right hand. I proceeded to go in the door. I took two steps on a level surface with first my left foot and then the right. The third step was down about 6 to 8 inches. I did not remember it, nor did I see it with the pizzas in front of me. My left foot hit very hard and caused me instant pain. My Achilles tendon had been jammed and was very painful immediately. I fell but did not lose my balance or the pizzas. It was awkward, at best.

The rest of the story was just as I said in my answer to opposing consul's interrogatory question 11 (the question was - were there any witnesses to the incident?) when I wrote "There was a person at the Boys and Girls Club at 1445 S. Chelton where I was delivering 15 large pizzas at about 12:30 pm on June 21, 2007 as I sustained the accident. He was in charge of the kids activities and directed me to the payment person. I said to him that I had hurt myself and suggested that the drop be marked better. The pressures of delivery and getting back to the store did not allow for a sustained conversation or a question and answer period so I do not know his name or even if he saw me fall". And of course, I reported the incident immediately upon my return to the store. The roughly two foot wide surface that was immediately beyond the door was marked with yellow and black diagonal stripes on the side the comprised the step down so it would be seen by people inside the building if the emergency exit needed using warning them of a step up. The was only a very thin stripe on the surface that could be seen coming from my direction but the pizzas blocked my vision from seeing it. It is routine for drivers to deliver large orders in the manner I just described (except for missing a step, of course).' Yes, I had a lowly job of a pizza delivery person. Not much of a career. But for 20 years I enjoyed bringing someone their dinner or lunch or late night munchies. It was a fun job with not a lot of stress that I just kind of fell into after getting away from the stress of management which I had been in for too long!. It also allowed me a great deal of flexibility in working hours and I was always able to get away to rescue Denver when he had a seizure a work that required getting him home to sleep it off. Anyway, after my delivery I returned to the store and reported the accident to my boss who was the General Manager of the store. This was required by our employees handbook. None of the stuff legally required by the state was posted in the store. She asked 'Do you want to do the insurance thing?' I replied that I had never been hurt before while working and that she was supposed to know what to do. Well, she did nothing. So, I finished my shift that day, getting off just a little early. At this point in time, she did not have anyone to fill my hours on the schedule. Myself and another driver borrowed from another store were taking care of business on alternating days although he worked 4 and I was only working three because of the care Denver needed at that time. He had a nurse stay with him the days I was working. My left foot was at a permanent 60 degree angle instead of 90 and was very painful. I kept on working for two more weeks in great pain. It go so bad that I could not sleep at night. I'd doze off for 30 or 40 minutes and the pain would wake me up. I'd have to dangle my leg off the edge of the bed for awhile to get blood flow to the foot and lower leg and then try to sleep some more. The second week after the accident I began sleeping in my overstuffed chair in the living room. I was aware that the other driver was making a transfer to come to our store full time and so I knew my hours would be filled and the customers taken care of. So finally on July 5th when I when in to work I told our assistant manager who was working that day that I could not do this any longer and needed to seek medical help asap. She called a phone number from her list of contacts and reported my accident to the workers comp insurance company. I listened to the conversation and it was reported truthfully. When she was done, I was given a phone number, the name of an adjuster, and a claim number. But she kept me working! I couldn't believe it. I finished my shift in continued pain and when I left to go home I asked what to do next? She replied 'I think you have to wait for the adjust to call'.

OK. That was Thursday, July 5, 2007. I was off the next day so I waited for a call that would never come. Finally around 11 AM I called the number I was given and got a voice mail message that he was out of the office until the following Monday. Great!! I left a message on his voice mail that identified me and the claim number etc. and added a statement that I had received no direction from my employer or him and I was going to the ER at Memorial Hospital which is what I did. ER on Friday 7/6 took x-rays but nothing was broken. I do not recall what else they specifically did that day and I can't read my own notes but I was told if it didn't get better to return the next day, which of course is what I did. The diagnosis on that day was a partial Achilles tendon tear. I was given an excuse from work and was referred to a podiatrist. I believe on that day, I was given a script for Percoset to help with pain. From that day until July 26th, my memory and notes are not complete, perhaps from the strong pain meds which did help a lot. But I did go see the podiatrist as his schedule allowed. I recall at one appointment that he told me that my limb was threatened and that I needed to get back to my vascular doc ASAP. I recall the podiatrist did put a big boot on my left (now diseased lower leg) which made matters much worse due to the underlying diabetes and PAD. My foot and leg blistered all over. The podiatrist ordered an MRI which was never done because the decision by my vascular doc to take the leg off made the MRI a moot issue. I don't remember what day I was admitted to the hospital. There were more tests on my leg and an operation to open up my left femoral artery in hopes of improving the blood flow. It didn't work. The leg had to come off. By this time I was yelling please take it off because that would be the only way to remove the intense pain. As we were preparing to take the leg,

 I remember my vascular doc saying that he was going to get me cleared by a cardiologist and then we'd go to the OR. Next thing I know, another vascular surgeon is on the scene. Seems like my regular doc had plane tickets to go some where. So me and this new doc had quite a long talk after he had reviewed my case thoroughly. He ended our conversation by saying that he does amputations 'as well as anyone in the business'. I was satisfied with him and the word around the hospital was that his operations took a little longer than other surgeons did because he was very thorough. I could tell that from our conversations prior to surgery. The cardiologist cleared me for surgery after a chemical stress test on my heart was completed and he deemed me a low risk for the upcoming surgery. I think the day before my surgery, this funny thing happened. New surgeon wants to do a procedure to increase blood flow to the left leg in hopes of getting enough blood flow to the leg to take it off below the knee instead of above. When I was waking up from this I found that I was in the recovery room strapped down!! I was accusing those in the room of being employees of a rival company and kidnapping me, preventing me from delivering my pizzas!! I was insisting this for maybe 5 or 10 minutes when some nurses and techs that I recognized appeared and I calmed down. Very shortly, everything was back to normal and I think the whole hospital heard about it and everyone had a good laugh!

2nd Blog Entry - The leg comes off July 26, 2007 Current mood: happy Finally on July 26th at about 10:30 PM we went to the OR and the leg came off just on the thigh side of the knee. I woke up the next morning in my bed and the prosthetist recommended by my vascular surgeon came in to put a cast on what was now my 'stump'. The reason for the cast was to prevent injury. It came off 10 days later as the stump shrunk from the swelling caused by the trauma of surgery. From this surgery, I went home on August 8 in a wheelchair. I was happy to be home and even happier that my wheelchair fit through all my door openings. I have 6 steps up to the front door of my home and had been taught how to get up and down with the aid of 1 crutch but someone had to handle the chair. While I was in the hospital this stay, I was taught how to bath (with a shower chair), use the toilet and in general transfer to and my wheelchair safely in a variety of situations. I felt very much dependent and too good people came to my rescue, Samanta and Rob. For the next several months I needed friends. Denver was gone and I was alone to face these things except for my faith in God and knowing that I had a personal relationship with Jesus.

Now here is a very cool story that must be more than just a coincidence. I'm lying in bed Sunday morning after my Thursday surgery and I turn on the TV to watch the Hour of Power from the Crystal Cathedral in Garden Grove CA. This had been a habit for many years. Denver didn't feel comfortable in church for fear of interrupting the service with a seizure. Anyway, on THIS SUNDAY, the guest interviewed by Dr. Schuller was a 24year old Australian by name of Nick Vijicic. Nick had been born with no legs and no arms. He was incredible in what he had learned to do and served as powerful inspiration to me after what had just happened. I said to myself that if he can do what he does with no arms or legs, surely I will overcome. Search youtube and you will find many videos of Nick. It solidified my belief that God really does have a plan for each one of us. Wow!

3rd Blog Entry - Blood Clot In The Lung and peeing blood! Current mood: cheerful So, it was good to be home after giving up the leg. I am actually quite happy because the pain is gone except for some 'phantom pain' which is sometimes even amusing. I've gotten some great inspiration and life is good. But it's not to last for long. A week and a day after coming home, I start experiencing severe pain on the right side of my chest. Back to the hospital via ambulance. Turned out to be a blood clod in my right lung (a pulmonary embolism!). Treatment was to start me on Coumadin (a very strong blood thinner). So, they sent back home again with a dose of 5 mg daily and to follow up with my family Dr. I go to see the family doc on Aug 24th. He looks at the discharge stuff from the hospital and sees that my INR was 1.4 and normal is 2.4 to 3.0. As I understand it INR is a blood clotting function. So, it appears low to him and he ups my prescription to 10mg daily.

By Sept 4th my blood is so thin that I have more blood in my urine than urine!! Back to the hospital on Sept 6 where they administer 2 units of fresh frozen plasma to reverse the high INR level. It was off the scale by this time. 10+! Back home again on the 10th of Sept and things quiet down a bit. I have to go to the Coumadin clinic once a week for a couple of months while they adjust it. Turns out 2mg a day is what works for me. This drug needs to be taken for 6 months after the incident and the clock gets reset with each new invasive procedure. Back in the hospital again on Dec 10th. Vascular doc wants to open up the femoral artery on the left side so that I have the best possible blood flow into the stump. Just in case I get a sore from the prosthesis, he wants it to be able to heal quickly. This surgery is uneventful and I am back home on Dec 13th. Christmas and New Years pass with no additional problems. But I still have surgery to face. What the vascular doc saw needed to be done before I lost my left leg. Nothing limb threatening or extremely urgent but we do need to have surgery on the right leg. Nor was there any thing limb threatening with the left side before the accident. Only the right side needed attention and we would wait on the left side! Well, the accident and amputation took care of the left side. I ask the vascular doc if we can wait until after the Superbowl to do the right side. He says no problem and we schedule the surgery for Feb 7th. I don't want to watch the Superbowl from the hospital! I'm also now ready for my first prosthesis and I also tell the vascular doc that I at least want to be properly introduced to my prosthesis with a short honeymoon! The prosthesis - coming up next

4th Blog Entry - Disability, legal stuff and Insurance - Oh no! It's AIG!! Current mood: happy Well, backing up just a bit now. While I was in the hospital for my amputation, I realized that I had heard nothing from this mysterious claims adjuster whose name I had been given on July 5th. After considering a lot of things, I really thought it best to engage an attorney. Somehow it seemed like I must. So, after a few phone calls to some firms, I selected what is probably the most experienced workman's compensation firm in town. The head of the firm came to my hospital bed and we reviewed what had happened and I signed an agreement with him on July 31st. After losing the leg, it was easy to get Social Security disability. Besides the leg loss, I also reported documented illnesses of diabetic neuropathy, claudication, diabetes, high blood pressure and peripheral arterial disease. I applied on September 18, 2007 and it was approved on December 3, 2007. Pretty fast for the government! I did this myself without the aid of an attorney. If all the documentation is in order and the diseases are qualifying ones, then it is not too difficult. One solid fact on my peripheral arterial disease is that my brachial index on my right foot was .30 when normal is 1.0. What is means is that there was just a trickle of blood flowing into my right foot as the pressure is measured at the ankle and below.

 Now, here is the sad part. Even with the help of the attorney, it took from July 5th until December 10th for the insurance company to admit liability and start paying me what I am due. This is sad mostly because Colorado law says they must start paying with 20 days after they first have knowledge of the accident. Well, the good Lord watches out. In December I was about of spendable cash, not having worked since July. In this month came my back Social Security and a nice check from the insurance company that paid me retroactive. I was greatly relived. I had taken early Social Security retirement benefits when I turned 62 so now they gave me an extra $250 a month. Very cool! Now all went well with insurance until this past June. They paid for a ramp along side my house to give me independent mobility and checks started coming every two weeks. Prior to that I always had to have someone carry my wheelchair up and down the six stairs in front of my house.

Here's a good chance to plug Silver Key Senior Services in Colorado Springs. From the time I left the hospital on August 8th 2007 after my left leg got shortened until I got the ramp in April of 2008, I used Silver Key exclusively for transportation. I would have been absolutely lost without them. Their drivers would handle my chair up and down the steps while I used my crutch to navigate the stairs. They were truly a God send. I wanted to be as independent as possible and not beg friends for rides. They did more than enough with moral support!! Well, so now AIG is all over the news with some whopping dollars thrown to them by our government. I've told my attorney we need to settle before two years is!! It is a concern for sure but in actuality, my checks come from and bills are paid by one of their companies, Commerce and Industry Insurance Company. It's still a concern even though we understand their domestic insurance is solvent and their problems are related more to investment that blew up in their face like everything else has. Sadly, the insurance company is WAY behind things. On my weekly check they show what they have paid out in medical bills around $33,000 to date (Dec 20, 2008). They've missed a LOT. My other insurance paid when AIG should have. There will be quite a time to sort it all out. I know they missed a lot because in March 2008 I have a hospital stay or 1 month. My regular insurance picked up the tab, but I had a $256 co pay from a bill that totaled $115,000. That didn't include surgeon's fees and other assorted bills. Enough of this unpleasant stuff. Next Blog entry will deal with my 1st prosthesis.

5th Blog entry - My first prosthesis So, now I have a stump that is healing nicely. The swelling is all gone and the staples removed (actually that happened on the 3 week anniversary of the amputation). I go to vascular doc on September 12th 2007. I ask him when is the appropriate time to start the prosthetic process and he says give 'em a call! So I do, and my first appoint is September 25th. It's been 2 months since my amputation. The first appointment is a bit of a disappointment. The stump gets looked at, we discuss what's going to happen and I am sent home with two "stump shrinkers" . Mind you, the proper term for my short limb is a "residual limb", but they do sell stump shrinkers. Most don't care what it's called - I call it a stump, but some will remind me of the proper term! I'm sent home with my new shrinkers and told to wear them 24/7 for two weeks. I have 2 so I can alternate and have a clean one each day. Good place to explain "stump shrinker". I liken it to a short piece of woman's hose. But thicker. It's a soft, breathable knit designed for therapeutic compression. It fits tight , over the entire stump. It has a hip attachment that goes around the wait, fastened with Velcro, to help keep it in place. Back in two weeks and my stump is again measured and casted for my "socket" along with precise measurements for my gel liners which will give my prosthesis a good solid fit to my stump. The shrinkers have worked fine and the stump shaped nicely. My prosthetist is pleased. A socket is the portion of the leg above the knee that grasps tightly to the residual thigh. I will have a mechanical "knee" and a non-articulate ankle. But, it's only my first leg, I am told. I begin to feel a bit like the beginnings of a bionic man. My right foot is also measured as well as precise height measurements to make certain everything is assembled so it will fit correctly. I'm told that my "test socket" and 1st leg will be ready November 29th. I also surrender my left shoe. A test socket is simply a "clear" socket so that when it is worn, the liner can be seen and the clear test socket marked for adjustment and then the final socket and leg will be made from it with an attempt to match the skin color.

My leg is finally ready for a test fitting and first steps on Dec 19th. I'm excited! The leg fits really good and I not only take my first steps, but walk probably a total of 100 feet or more with it, but of course within parallel bars to so it was just several trips back and forth. The leg feels good to walk on and it's nice to be able to stand on two feet. Some final adjustments are needed and I am finally able to bring this $15,000 high tech leg home on New Years Eve, Dec 31st, 2007. I though this to be a real reason to celebrate and I did! I had to throw in the approximate price here because I laugh to this day every time I put it on. Such a high tech state of the art leg for my purposes, is strapped on by a piece of Velcro!

6th Blog Entry - A failed fem-pop bypass Well, the honeymoon with my 1st prosthesis is over and it's time for the planned surgery on my right leg. During the month or so that I've had my "new leg, I've had mild success using it but still a very long way from full weight bearing on it. My vascular doc has ordered home physical therapy during this time which was a huge help. The operation to re arrange the plumbing on my right leg goes off on February 7, 2008 as planned. But, there is a problem. I have a LOT of swelling in my lower leg that is giving a problem healing. The skin just does not want to come together on a 6 1/2 inch incision on my lower leg that starts 1" above my ankle on the inside of my leg. In spite of the poor healing, I am walking on my prosthesis using a walker for stability for a distance of about 150' when I am discharged from the hospital on February 14th - just 1 week after the surgery. Home physical therapy continued but my incision fails to heal and is slowly spreading apart. A home nurse is ordered to help me keep the wound clean but it get progressively worse. Back to the vascular doc on March 5 and 12. On the 12th we decide we need to go the operating room to clean up this mess. That is scheduled for March 18th. It goes OK but a second session is scheduled on the 20th, just 2 days later. At the second session, they discover the bypass has failed and a new plan of attack must occur to fix the failed bypass.

7th Blog Entry 2nd Bypass Surgery March 25, 2008 & Skin Graft April 5, 2008 Current mood: happy My surgeon is awesome. After some new arterial studies of my right leg and left stump, the surgeon decides that we can harvest a vain from my stump and use it to cross over the bone in my lower leg from left to right and hit the right arterial artery to get good blood flow to my right foot which is again at a trickle. This operation, however, will come with a price. The price is that I have to agree to stay in bed as long as necessary before getting up. After the swelling and the 1st failed bypass, we don't want to take any chances of a second failure. Of course I agree and the operation goes off without a hitch. A plastic surgeon had been consulted on the 2nd clean up operation to look at the feasibility of a skin graft to repair the huge gaping hole in my leg. He likes the look of the area but postpones the skin graft until April 5th. The skin graft goes off perfectly after harvesting skin from my upper thigh on my right leg. It requires a layer of skin one twelfth of an inch thick, 2" wide and 5 1/2" long. After the operation a wound vac is applied to the area with strict instructions from the doctor not to touch until he is ready. Normally it would be changed daily by a special wound care nurse. On April 10th, the wound vac is removed with the wound care nurse and the plastic surgeon. They are very happy that the graft has taken just fine! One more hurdle crossed. The day after the wound vac is removed, the vascular doc allows me out of bed for an hour twice a day. Things go well and I am allowed up the next two days with instructions to use my right leg like I would at home. The brachial index in my right leg upon later testing would reveal we've achieved a .9 level where it was .3 prior. 1.0 is considered normal. My foot is happy it's getting blood again and much of the pain I thought was due to diabetic neuropathy is receding. My foot is pink again and has a nice pulse taken on the top of the foot, It goes quite well and on April 14th I am home once again. I've been here since March 18th, so I am more than ready! I am discharged once again to home physical therapy.

 Who are my heroes? Current mood: thankful As I look back over the past 50 years or so, the people I have listed as heroes are simply the people who have had a very positive influence on my life far and above all of the other friends and acquaintances I've made over the years. Simply the best of the best. This is not to say that EVERY friend and acquaintance is not cherished because they are. Some simply rise above the rest. New Photo Albums. Current mood: ecstatic I have thousands of pictures from the day I was born until now but I'm not looking back as far as myspace goes, except perhaps for some special people. For now, I've created 4 new albums today. One that goes along with my Blog entries pertaining to my accident and leg loss. Another album has a few pictures of Richard and Nikko. Richard rents a room from me, while his son, Nikko lives with his very nice Mom. Nikko is one of my heroes, a very sharp and pleasant 13 year old and is a real bright spot in my life. A third album is Christmas 2008 at Samantha's, another hero! The pictures in this album were all taken by the kids in the photos. They took turns and by request, I've uploaded the best of the many they took. All the kids are very special, they call me Grandpa Ralph and I am honored and pleased. The 4th album is some recently found pictures of some heroes in Florida during the late 1970's.

 A special tribute to Nikko Current mood: blessed One of my heroes is Nikko and I recently had the opportunity to spend Christmas Eve with him, his Mom, her parents and her lovely sister. I would not have traded that wonderful evening for anything. But that is just public announcement of a good time. Thank you, Nikko for handling my wheelchair. And a big thanks to your Mom for she provided the ride in circumstances that she would rather not have driven. I've interrupted my Blog posting for a few days as I reflected on that evening and the friendship I've had with Nikko over the past year. After losing my very best friend of 25+ years and then losing my leg less than two months later I could have fallen into deep depression. In spite of my outward appearance to many, I grieve greatly every day in private more than I can relate in words. Anyone who has lost a loved one knows that time does not make the grieving and the emptiness go away. It just makes it easier to deal with. This is and has not been an easy time at all in spite of outward appearances. It is the love of God that gets me through and Nikko! Nikko is my hero because he has brought a true spirit of friendship, laughter, care and compassion that has been totally unexpected in a time of deep despair but welcomed as another one of the Angels I see walking the earth. Thank you, Nikko for being you and for being in my life. I love you as the spirit of God loves you flowing through me and you will find this love to always be patient, always kind, always without envy, and without boasting. My love for you is not self-seeking nor easily angered. It will not keep any record of wrongdoings like slews and r+ (a private joke here that Nikko understands) and will always seek the truth about everything. My love will always protect if needed, hope for the very best for you and will persevere always. I hope that I can continue to be a positive influence in your life and a good friend for a very long time to come and you can be absolutely certain that my life has been much better with you in it than it ever would be otherwise. Thank you, Nikko! God loves you and so do I.

He wants me to do it on one leg! Current mood: happy Time here for what I think is a funny story. A number of years ago, I was talking with my friend, Ruby. I was wondering out loud to her as to why God had kept me alive this long. My father died of a heart attack when he was 45 and I had a mild heart attack when I was 47. Her answer was simple, "to take care of Denver". It took some time for that to sink in but I now certainly understand it. So after I lost my left leg to an accident, I was talking with my awesome Christian friend, Fay, in Florida, who is also a friend of Ruby. We were pondering what plan God has for me now and her statement was "I don't know, but whatever it is, he wants you to do it with one leg!" Ruby and Fay, I love you both and so does God!

Another Hero – Samantha Current mood: thankful After losing my best friend Denver and then my leg two weeks later, thinks were pretty bleak. I could not drive, had surgeries scheduled earlier than any mobility transportation that I could arrange and needed shopping, prescriptions etc. picked up. I simply could not have survived this huge change in my life without the friendship and support of Samantha and her family. She was always there, every time and never let me down once even though she had more than her hands full with raising 3 kids, scheduling school time etc. Samantha is another true Angel that I see walking the earth. I love you always and your children will always be very special to me. I am honored indeed that they call me Grandpa Ralph!! God does love you and so do I.

8th Medical Blog Entry - learning to walk again Current mood: happy Well, it sure was good to be home after nearly a month in the hospital, in bed without any activity at all except for the last 3 days before I was discharged. I can't believe how weak I had become! Getting on and off the toilet was even difficult. My home physical therapist secured a raised toilet seat for me, which helped a lot then and still does now when I am wearing my prosthesis. Home PT is ok. I start working with my walker while wearing my prosthesis and even try crutches for a brief spell. Progress is slow but steady and I am pleased. Back to the vascular surgeon on May 7, 2008. He is pleased with my progress and writes a script to begin outpatient rehab at Memorial Hospital where I will work with a Dr, of Physical Therapy.

 9th Medical Blog Entry - A simple mistake and big pain comes my way. When my vascular Dr wrote the script for PT, because he had been working on my right side recently (fem-pop bypass and revision), he mistakenly wrote the script and treat and evaluate r AKA. That would mean the right side and not the left. So, when I go for my first evaluation, the therapist evaluates the left side. But, because the script had mistakenly been written for the right side, the therapist wrote the evaluation notes for the right side. This happened on June 1st. I was able to get in 3 sessions with the Therapist when the insurance company stopped authorizing any treatment and stated through their counsel that they would not pay anything on the right side and they requested a hearing non the matter which would not be until Jan 27th, 2009! I am very bummed out by this. I am thinking that I must now not get any help in progressing until January, which is 6 months away. The sad part is that it all could have been straightened out with a few phone calls. My attorney keeps trying to resolve the issue . Well, it turns for the best anyway. During my rehab, I am having great difficulty pulling off my prosthesis while walking using parallel bars at this point. There is great show stopping pain occurring right underneath my stump. This really was not new but the therapy brought out the worst of the pain.

 On July 1st, therapy once again resumes but the pain is getting worse. During July and August I am back to my prosthetist seeking adjustments, Finally a point is reached when there is no more adjustment to be made. Therapy continues until Sept 15th when is once again canceled for lack of insurance coverage. Good thing because I really can't walk on my prosthesis due to the severe pain. September 30th is a memorable day! No more Coumadin! It's been 6 months since my last invasive procedure. I thank God for this as the Coumadin therapy required weekly blood testing to measure the clotting time and adjust the dosage. A real pain. I'm now on Plavix which is safe and effective.

 10th Medical Blog entry - 3 shots in the back! Current mood: happy My vascular Dr finally refers me to a pain specialist who administers 3 shots in my back 2 weeks apart to block the nerve that is causing my pain. This works like a charm!

While all this is going on, I am diagnosed with bi-lateral carpal tunnel syndrome in my hands from wheeling my wheelchair for 14 months. The onset was probably six months before I asked for help. It got so bad that it was painful to put my socks on or hold a cup of coffee. A shot of cortisone in each wrist gave immediate improvement. Hand surgeon says I'll need an operation on both hands but not until I get out of my chair. In the meantime, I can go back for more shots to the wrist as needed. I can also go back to the pain Dr for more shots in the back as needed.

11th Medical Blog Entry - Finally, the right Dr. Current mood: fabulous My rehab is stalled and I had not had any sessions since September 10th and it's now into November. I had gone to see the rehab Dr at the hospital who is just an awesome Dr. He said that he'd be glad to oversee my rehab but suggested that one of his colleagues could do it better since he was very familiar with workman's comp and know how to navigate the system. I tell my vascular Dr and he makes the referral. I meet with my rehab Dr on November 10th and by the 13th my rehab has started again. I'm very happy. I'm able to put full weight on my prosthesis and start walking on the parallel bars using just my right hand. I quickly graduate to a 4-point cane although it's a little shaky. Things go really well and I make great progress until the middle of December.

12th Medical Entry - A sore stump! Current mood: happy This is probably a good place to once again say that to make any sense of all this, go back to my 1st numbered Blog post and read forward sequentially from there. On Sat, Dec 13th I was walking well with my prosthesis and my walker but I felt a great sore develop on my stump. My therapist sees what he thinks may be vascular issues and suggests that I check in with my vascular Dr. . I do and an ultrasound is ordered. I also check in with my prosthetist and he determines that my stump has shrunk considerably and it's time for a new socket. I've had this socket for a year now so it is time for a new one. I am casted for the new socket and the test socket is ready on Dec 29th. Meanwhile, the ultrasound study shows a 73% blockage on my left femoral artery due to scar tissue ( from an earlier procedure probably). A CAT scan is ordered and if it confirms what the ultrasound showed we'll be back in the OR in January. The Dec 29th test fitting of the new socket went well and feels much more comfortable with my stump. As of now, my prosthesis will be ready on January 15th and my CAT scan is set for January 13th. Rehab continues with muscle stretching exercises.

 13th Medical Entry - The emotional side of all this. Current mood: happy Well, I'm not superstitious, so 13 doesn't bother me. I'm thinking this is a good place to examine the emotional side of all this. Losing a leg above the knee I guess would be very traumatic for most people. It was not for me. From the date of my accident until the amputation I was in constant and severe pain to the point that I could not even sleep at night. I would sleep maybe 30 to 45 minutes and the pain would wake me up. Percoset would not control the pain. I would have to dangle my leg over the edge of the bed to get flood flowing to it and stop the pain. The last week prior to going into the hospital for what would be the amputation I slept (little as it was) in my easy chair. It helped. So for me, it was "please take it off and stop the pain". If you go to my website "realatc.net" and follow the links to my personal page you will find photos of what my leg and foot looked like a week prior to the amputation. Myspace said they were too gruesome to put in the photo album. Right after the loss and to this very day, the absolute hardest thing for me has been reaching out and asking for help. If you've read me Tribute to Denver Mendenhall, you'll perhaps understand that I was always a provider to the greatest person I have ever known. For 25 years I was a caregiver and the one who could always be counted on. Knowing, loving and caring for Denver kept me from marriage and children. That's OK because it is and was God's plan for me. There is no question in my mind about that. Denver's death was more of an emotional time for me than the loss of my leg but life must go on. So, I found myself all alone with few friends and no leg. The car I had was a 1994 Suzuki swift. Great for delivering pizzas and for around town, but with the loss of my left leg, I knew I could never drive it again so I wound up selling it to a dear friend's uncle. So now, I don't even own a car. The friends I did have and still do were absolutely super in every way. My heroes, Samantha and Rob came to my rescue and although I really didn't like leaning on them, I had no choice, but it hurt my pride. I learn to be as independent as possible by using Silver Key for transportation to and from DR’s appointments and I used shop at home from King Soopers a couple of times a month. When I finally got a ramp along side my home which I think was in April of 2008, I could use Metro Mobility for transportation. So things are not so bad but there is a financial side to all of this also.

 14th Medical Entry - The Financial Side I had taken early retirement at 62 and had planned on working for a very long time. Denver had been getting Social Security Disability for quite awhile but that ceased upon his death. And my 3 days a week of part time work vanished a month later when I lost my leg. Well, everything was caught up for awhile so I was OK but I knew I needed to supplement my income somehow. I tried advertising my master bedroom with a private bath with no success. Lots of lookers but many looking further out than I thought appropriate to me. After I let go of worrying about things and just turned it over to God two days later I got the perfect response to my ad. A guy named Richard, an electrician by trade who was looking to relocate back to Colorado Springs called me, came to my home and has been here ever since. Only problem is the past 10 months or so he's been working out of town so I only see him on the weekends. To make a long story short, he's been a real blessing and has helped out more than I can say. I appreciate him and his generous nature. We clash greatly when it comes to TV watching but all else is well. He likes to cook on the weekends and we call him Chef Richard. We, in this case, consists of Nikko and myself. A week or so after Richard was here he asked me if his son could visit for the weekend. This was one of the times when God clearly whispered into my ear. My first instinct was to say no but I heard God and said yes and so it was my very great pleasure to meet Nikko. And he's been here weekends ever since. We hit it off immediately and the joy and laughter he brought to a grieving household was exactly what God ordered at the exact right time. He has been an absolute godsend - an Angel sent at the right time for the right purpose. He's enjoyed my flight simulator passion and gotten quite good at using my computer and all it has to offer. We also share an affinity for Xbox360 games. His Mom has told me she thinks that's why God sent Richard my way. I've already written a tribute to my friend, Nikko so no need to repeat it here and I've gotten way off the topic of this entry. With money running out, in spite of Richards help, I was in a big panic by December. I leaned hard on my attorney and finally the workman's comp insurance co stepped up to the plate with back pay to the date of the accident. Thank God. He knows our needs but sometimes waits until the last minute to show his hand! In December also, my Social Security Disability was awarded with an nice monthly increase plus back pay retroactive to February 2007 which is when I was declared disabled due to my PAD and other things. So, things have been going along OK. I manage to keep my head above water but not very far! And there is little room for error or any capital expenditure like another car. I have to learn to live on my $1104 a month SSDI plus my $388 a month in workers compensation. There are times when extra money from things like a stimulus check and Colorado's LEAP program makes possible fun things like a dinner out at Red Lobster. Also, a couple of times a year I get 3 checks in one month so that helps a lot. What Richard contributes now somewhat goes right back to Nikko in food, Netflix and shared computer and video games interests and Richard seems oblivious to the fact that Nikko is a regular weekend guest. I could ask but he's a grown adult and knows what things are like. Oh well, I have no problems because Nikko has gone from Richard's overnight guest to my weekend guest and that's just fine with me. My case will most certainly be settled this year and I'm probably 3 months or so from reaching maximum medical improvement at which time I'm told we'll settle. We'll see.

 15th Medical Entry - New Socket Current mood: happy My new socket was ready last Thursday Jan 15th. It feels really good and yesterday (Mon Jan 19th) my Physical Therapist gave me quite a workout including quite a distance with a 4-point cane! I was quite surprised at how much easier it was with the new socket and my balance was much better. It's sort of like learning to ride a bike where each session is so much easier than the last. I'm quite excited! Last week I also had the CAT scan of my aorta, trunk and lower extremities (short leg on the left!). Tomorrow I'm off to the vascular surgeon to discuss the results of the CAT scan. I'm hoping I won't need any surgery but there's a good chance of going back to the OR to open up the femoral artery again if the CAT scan confirms the earlier ultrasound.

Saturday, January 24, 2009 16 Medical Entry - good walk and back to the OR Current mood: happy Three days ago I had an appointment with my vascular doc as a follow-up to the CAT scan. And yes, it's going to be back to the OR on February 10th to "Redo Left Common Femoral Endarterectomy and Angiogram Possible Iliac Stent". Well, that was expected based on the ultrasound a couple of weeks ago that the CAT scan now has confirmed. It should be a fairly simple procedure but the surgeon requested the OR for 5 hours! Maybe not so simple after all. Anyway, my new socket feels great and I walked a lot this day at the hospital (vascular surgeon's office is at the hospital) and saw old friends on the rehab floor and on the surgical step down unit. I did get some soreness on from the walk as the socket was a bit long in the groin area. I went to the prosthetist Friday for an adjustment. It feels a little tender still but I am able to walk better. It might need a further adjustment but time will tell. For now, it feels great to do some decent walking again!

Tuesday, January 27, 2009 17Th Medical Entry - O Happy Day - Mobility on its way! Current mood: ecstatic When I had the accident that led to the loss of my leg my vehicle was a 1994 Suzuki Swift with a manual transmission. Realizing that I could never drive it again with my left prosthesis I sold in April of 2008 for $300. Even if it could have been converted over to a hand-operated clutch, it was still too small of a car to get in and out of easily with prosthesis. Where I live there is a central mailbox area for a community of about 500 homes and the mailbox area is about 400 yards from my house. So, all this time I’ve been unable to get my own mail. I've had to rely on friends to get my mail on a weekly basis. Also a King Soopers shopping center is 2 miles from my home but I have to have a minimum of $50 and they charge $9.95 to deliver. That gets expensive. So, back in August of 2008 I was discussing my mobility problems with my vascular doc and he wrote a prescription for a "motorized wheelchair". I sent the script to my attorney who forwarded it to AIG (insurance co) and they came unglued!!

Through their attorney they forwarded fragments of my medical history to an independent medical examiner. This examiner formed the following opinion: "There has been a request for a wheelchair, and subsequently for a motorized wheelchair. It would appear that the need for a wheelchair, motorized or not, would, within a reasonable degree of medical certainty, be due to his preexisting bilateral circulatory leg problems (and not his work related injury to his left ankle)." Excuse me, but my circulatory problems on the left side were taken care of by the amputation in July of 2007 and on the right side by my surgeries in the winter/spring of 2008. One thing to note is that motorized wheelchairs can run up to $40,000 and a power scooter is more in the range of $2,500. My vascular Dr was really just responding to my cry for mobility in a way he wasn't even versed in. My family Dr wrote a script for a power scooter and subsequently my rehab Dr also wrote a script for a power scooter. Both of these scripts also carried the bilateral carpal tunnel syndrome diagnosis. So, yesterday I get a call from my medical supplier who tells me that AIG has approved the power scooter and they would order it and expect 5 to 7 days to get it in house and ready for delivery!! This is the same insurance company that denied it based on their own independent medical examiners opinion. It pays to be persistent!! Monday,

February 09, 2009 18th Medical Entry - Emotional rollercoaster Current mood: blessed Well, this past week has been a little difficult but wound up just great. I went for my pre-surgical appointment on Tuesday and all was well until the next day when I get a call from my vascular doc's nurse that my white blood count was a little high and she quizzed me on my general health. Did I have a cold or sore that's not healing. Do I feel OK? Yes, I feel fine so she said she would let the Dr know. This morning I get a call from the doc's office confirming my procedure for tomorrow so I guess all is well. Back to last week. On Thursday I decided that I'd waited long enough for my power scooter so I call the Medical Supply Co who is handling it all and speak to my rep there. Seems like her call the previous week was premature. She said it had been approved but they had not received anything from the insurance company in writing that they would pay for it. I also learn on this phone call that a new adjuster was handling my case now. This is the 7th or 8th person who has had my file. They used to send a letter when adjusters changed but no more. Seems like they requested a copy of the script, clinical notes and quote on the hardware. So, back in limbo again - will they or won't they and why did the supply company tell me it was approved on January 26th and they were ordering it right now and expect delivery in 5 to 7 days? Then on Friday I get my mail for the week. There is document exchange sent to me by the insurance company. They just started sending these things the past month or so. According to the attorney, they should have been sending copies of all reports all along. Oh well. Anyway, in the exchange is a copy of the radiologist report of my last CAT scan, which determined the need for my impending surgery. So I read the report and all is well until I see that gallstones are layering within the gall bladder. Great! One more thing to worry about. This past week I also learn of the death of an old friend as I am writing about the period in my life that this friend was prominent in. For a few months now, I am used to my angel Nikko arriving on Friday evening for the weekend. He always calls to tell me he is on the way. On this Friday no phone call will come. Not wanting to infringe on him I do not make a call. I could have but I just thought it best to wait to hear from him. Sure enough, Saturday afternoon around 3 I get a call and he's on the way. Great. A crappy week is now going to have a great finish and I need it. Needless to say Nikko and I have a wonderful weekend full of games, movies and genuine heart to heart talks about things that matter in life. Thank you Nikko, once again for being there to lift my spirits up!! In reflection of my closeness to Nikko that had been right out of the Chaos theory of mathematics and strange attractions to be sure. For whatever reason, Nikko and I have bonded very closely. In reflection of our friendship and the way it has developed I am reminded of a book I read as a youngster called "The Old Man and the Boy", by Robert Ruark. .. ........ The Old Man is his grandfather, who taught him a lot about hunting, fishing, and life in general. It reminds me that really any older person who has an opportunity to bond with someone much younger really has an inherit duty to pass along wisdom for the ages as they travel through life. To be a pillar of strength and wisdom. Parents teach about life from one level or perspective. Add a generation and you have many more years of life's experience to pass along wisdom from. It's a different level and one that cannot be duplicated. As I reflect further, I think about heroes and Angels. Here on myspace I've listed a host of people who I consider heroes. These are the people who have had nothing but a positive impact on my life. When I think of Angels, I know of two. People who God put in my life at a time when they are desperately needed who literally have a life changing effect. The first was Denver and the second is Nikko. I am convinced it is all God's plan and I am grateful and awed by my heavenly Father's grace and wisdom as he has always known my needs and put the right people in my life at exactly the right time. Praise God. Hallelujah! It's on to the hospital tomorrow for my procedure. I'm not worried or concerned - just happy to get it over with. My hospital stay should be no more than three days. I'll be happy to let them wait on me for awhile.

Date: Feb 17, 2009 19th Medical entry - Successful surgery but bad news Current mood: thankful Well, my operation went off as scheduled at 9 AM on Feb 10th. As was with my similar surgery 14 months ago, I am in need of NO post op pain medication. When I see my vascular surgeon the next day he complains that I made him work awful hard and I remind him that as we were talking about my upcoming need for the surgery he said he was bored!! He was kidding then but his news today was more serious. I can tell he dug deep by the massive bruising on the underside of my stump. What looked like either scar tissue from the similar surgery 14 months ago or additional plaque buildup on the CAT scan turned out to be a CLOT! Not good news for sure and it makes a case that I will be on the blood thinning drug Coumadin for the rest of my life. This drug is a pain in the butt as it requires constant finger sticks to measure the therapeutic level. This level is on a scale of some factor called INR. For me this ideal range is between 2.4 and 3.0. On Friday the 13th, my INR is only 1.2 after being started on the dose that got me into the proper range, which was 2 mg a day. The Dr wants to keep me in the hospital until it's adjusted. I ask if there is any negotiation. I want to be home. With the following Monday being a holiday (presidents day) my angel Nikko had been looking forward to the extra day at my house to celebrate my successful surgery and to help in whatever way he can if I'm having any problems. What a cool dude! So, I get to go home but on Lovenox. This requires two shots a day to be administered by me and then two weekly INR checks to be done by a home health nurse. The Lovenox will protect me while my Coumadin level continues to climb into the proper range. The clinical nurse at the surgeon’s office will monitor the results and make any recommendations for changes to get me to the proper level and maintain it. The Lovenox is VERY expensive. A five-day supply is $722 and I will need at least two refills! So even at $2100+, it's still cheaper than another day in the hospital and I can handle the shots OK. I had been sent home with Lovenox after my amputation. So all is well as can be. I cannot weight bear on my stump for two to 4 weeks. I have a follow-up with my surgeon on Feb 25th. While I was in the hospital, Nikko and his Mom came to visit and that was special. I also run into a host of familiar nurses and lab techs all of whom are glad to see me but wish it was just visiting instead of being an inpatient. My long weekend with Nikko was very enjoyable. Samantha and my grand kids also stop by to see me when I'm home. I'd talked with them on the phone while in the hospital but there was some illness and I asked them not to visit until they felt better. Well, that all for now.

Friday, February 20, 2009 20th Medical Entry - Mobility at last Current mood: ecstatic Well, after a year and a half of being home bound other than medical appointments, hospital stays and a very occasional outing, I finally got delivery of my scooter today. It's a Pride Mobility Celebrity XL model. Color blue and 4 wheels. It does a whopping 6 miles an hour and gets about 17 miles per charge! There are no words to adequately express my elated feelings at the moment except to praise God and WOW! I can't wait to take it for a good test spin later today. I have my PCP person here at the moment doing the cleaning. As soon as she leaves, I'm out the door to at least get the mail on my own for the first time since July of 2007. From my recent hospital stay and surgery, I was discharged with a prescription for Lovenox. This required two shots in the belly daily about 12 hours apart and was a safe way for me to come home until my Coumadin level became therapeutic. I was also discharged to home health care with a nurse twice a week to check my Coumadin level. As luck would have it, I became therapeutic Thursday, so no more belly shots. There is a recheck ordered for Monday so hopefully all will be well. Most of my bruising has subsided now but my stump is still swollen and I have a pinkish discharge from my incision which is subsiding slowly.

 Tuesday, February 24, 2009 Scooter works great!! Current mood: happy Yesterday I went to King Soopers (major grocery store) and did some shopping. It's about 2 miles and my new scooter did just fine. It took me about 5 minutes longer than I thought but I did some experimenting a little. I think I can find a little bit better route! Measuring distance on a map, Walgreens is just a little closer than King Soopers is. That's where I get all my meds and misc. supplies so I can be pretty independent now, weather permitting. It feels good. Tomorrow, I'm back to the vascular surgeon for a 2-week check up. I'm still bleeding just a little from the huge incision - just a pinkish discharge and not blood red. Yesterday my Coumadin level (INR) was 2.8 - up from 2.4 last Thursday but still a good range. Have to have another recheck on Thursday. I'm anxious to get back into rehab. Stump, however is still swollen and the Dr did say 2 to 4 weeks before I can weight bear. The company that arranged my scooter also arranged a 4-point cane for me so I'm good to go as soon as I'm cleared. I suspect that all of the minor bleeding will have to stop also before my stump is cleared for duty!!

 Thursday, February 26, 2009 21st Medical Entry - Back to the OR Current mood: happy My appointment with my vascular surgeon yesterday was just a little disappointing. I have an incision in my groin area that is not closing and healing properly. He wants me back in the OR Friday but I beg till next Tuesday. This Friday, Nikko, his Mom and friend Doug, and I have plans to go to the Red Lobster for a long overdue dinner. Nikko has some upcoming surgery to face. A bone spur on his leg. And, this is a birthday dinner out long overdue - Nikko's birthday was Jan 24th. We've been waiting a little for me to weight bear on my prosthesis so I could go with a walker but so long as Nikko wants to handle my wheelchair for me then we're taking our best shot!! Surgery next Tuesday should go OK. He wants to keep me overnight just to be safe and he's started me on an antibiotic just for good measure. Nurse came early today to check my INR. It's 2.6 down from 2.8 and right in the range they want it. I'll have to stop in a day or so to prepare for my surgery. It's a nice day today so I'll be out and about on my scooter!

 Wednesday, March 11, 2009 22nd Medical Entry - The best laid plans? Current mood: happy Well, My surgery on March 3rd turned out to be not so simple. My surgeon found some dead tissue in my non-healing wound and that changed everything. Also examination of the wound prove the need for wound vac therapy if it ever to heal. It also called for massive antibiotic infusions. Although my blood cultures show no infection, he's treating it as if it were infected. So I spend a week in the hospital instead of a day and am now on home health care. I have a portable wound vac machine and will have a nurse at my door 3 times a week to change the sponge on the wound. Very painful so my doc has given me a liberal prescription of Percoset to self medicate myself about an hour before the scheduled change. I will have to wear the wound vac machine 24/7 for an estimated 6 to 8 weeks. I will also have daily antibiotic infusions of Vancomycin through a picc line in my left arm. This will continue for 6 to 8 weeks also. In addition to the above I am also taking the oral antibiotic Levaquin. So, once again, another bump in the road. Good news will be after all is healed I'll be back up on my prosthesis and back to outpatient rehab. 8:30 PM Friday, March 13, 2009 23rd Medical Entry - Picture of non-healing wound Current mood: anxious I posted a picture of my non-healing wound. It can be found at my website: realatc.net. Just follow the links to my personal pages and at the bottom is the link to the page where its posted - same page as my failed fem pop by pass pictures.

11:37 PM Friday, March 13, 2009 Bad news from my Workers Comp insurance company Current mood: irritated Yesterday I got a call from my vascular surgeon’s nurse. She had been talking with the current adjuster and was informed that they had pulled him off of my case (said they sent a letter which he never received) and had referred me to another Dr. I have no such referral and the timing of this is ridiculous. I'm at home with a wound vac attached, my INR in limbo and waiting for my attorney to call to help sort this out. It makes no sense whatsoever - we're at the end of all this anyway but to leave me hanging with no physician is inexcusable. DR’s nurse said that the insurance company was acting on advice of consul. I'm really bummed out by this.

 6:26 PM Sunday, March 15, 2009 More Bad News - Blown Picc line & no infusion Current mood: annoyed Well, things are seemingly downhill at the moment. On Friday my picc line refuse to cooperate. So, on Friday and Saturday I received my Vancomycin infusion through an IV. This drug is bad for veins and it took multiple tries to get through the infusion. On Sunday, the nurse couldn't get an IV started at all. So, I have no choice, without a doctor to fall back on thanks to my insurance company, to present myself at the Emergency Room tomorrow morning and hope for a new picc line. To think I have to go through this for the next 5 weeks or so is very discouraging. Oh well, life is still good. Nikko spent a long weekend with me and it helped more that I could say to take my mind off of my problems. A big THANK YOU to Nikko's mom for allowing him to be here. One of my true heroes, Nick Vijicic was on the Hour of Power this week and it was good to see him.

8:49 AM Monday, March 16, 2009 24th Medical Entry - Clear picc line and pressure on the Insurance Co Current mood: disgusted Well, I got to the emergency room at the right time (10 AM) and was in and out in just a little over an hour - with my picc line cleared and this afternoon's infusion went just fine. Tomorrow will be blood draws to check my levels of Vancomycin and my INR. The wound vac change went well today and I'm scheduled to have it changed every Mon, Wed and Fri until it's healed. Talking to the attorney, they are putting pressure on AIG to rethink pulling my vascular DR from the case under the threat of filing for an emergency hearing which they are prepared to do tomorrow. Then in today’s mail, I get a denial of a claim for service in January from the Hospital. They just don't get it. Everything that has happened since last April has all been related to the left side of my body and blood flow/rehab issues to prepare my residual limb for the best possible situation for my prosthesis and return to work. We'll keep fighting and will win out in the end. But what aggravation in the meantime.

 7:54 PM Wednesday, March 18, 2009 AIG is misinformed and their counsel lies Current mood: angry Still trying to sort out AIG's current problem with my case through their attorneys, yesterday I get a call from my attorney saying that AIG wants to change doctors because my vascular surgeon has retain his own consul and is refusing to forward requested documents. So, I call my surgeon's office and his clinical nurse just laughs because she is the one that sends off all requested documents. As a matter of fact, I have my surgeon's latest operative report in my own hand received from AIG's document exchange. The nurse is even in phone communication with the current adjuster. Adjuster says a letter of doctor change was drafted on March 12th but no one has received it - not my doctor, not my attorney and not me. Nurse said yesterday that she was told it would be faxed and it never was received. Well, I have a follow up visit with my surgeon today so I can ask him directly and I know he will tell me the truth as I know his nurse has. My patience is being tried but not my faith.

 Wednesday, March 18, 2009 Straight talk from my surgeon and sneaky opposing consul Current mood: amused Today I saw my vascular surgeon in follow-up. Medically, things are fine. He did have in hand a letter from opposing consul terminating his services. He wants to refer me to a plastic surgeon but he can't since he has this letter. We talk at length and he assures me he will follow up until another qualified vascular Dr is secured or they rethink his position. I ask him about his attorney. What happened is that he had his firms attorney (he's part of a PC with 8 or 9 other doctors ) draft a letter to opposing consul that reiterated his position that he is not the one to determine my maximum medical improvement. Opposing consul has been pressuring him for that. He's a vascular surgeon and they are asking for an opinion that he is not qualified to give. I had been referred to my rehab Dr from him. The rehab Dr must make that determination. My rehab has been interrupted by my latest surgery and a vascular Dr must clear my stump before rehab can begin again. So, this afternoon I get a call from my rehab DR’s secretary. They had a call from opposing consul asking for a referral to a vascular Dr. Absolutely crazy. He's not the right Dr to make that referral and it would be unethical in the first place since I was referred to him by my vascular Dr. She says that they will ignore the request. My vascular Dr. says that this game playing is impeding my medical progress.

 Saturday, March 21, 2009 I was wrong about a new Dr referral Current mood: bummed Well, yesterday I get a call from my rehab DR’s secretary to let me know he had referred me to another Dr and made an appointment for me. She said this only after saying that he'd talked with opposing consul. I really feel like I am being pressured to do something that I don't want to. Is there such thing as a hostile patient like a hostile witness? I simply hate the thought of leaving the care of a good Dr. who has cared for me for so long, especially since there are no medical issues involved. Date: Mar 23, 2009 25th Medical Entry - getting ready for new Dr appointment Current mood: argumentative Well, this new Dr is not a vascular specialist but a general surgeon who does all types of surgery. He's been practicing for 30+ years but my main concern is whose side will he be on, mine as a patient or more concerned with the insurance company. I really feel like I'm being tossed to the wolves. Regardless, I will cooperate since I have no choice. I will even take him two pictures of my non-healing wound where the wound vac is - one taken on Fri March 20 and one that we will take today. The nurses who come to change my wound vac every Mon, Wed and Fri all say the wound looks like it is healing just fine.

 Date: Mar 24, 2009 A wasted afternoon with new Dr. Current mood: mad Category: Life Well, this afternoon I go to an appointment with this new Dr. that opposing consul has arranged through my Rehab Dr. New Dr. asks "Why are you here?". My response is that I do not know. I tell him all that I know about who and why the appointment is arranged. He says regardless, since I have been under the care of a Dr that I know and trust, I cannot be forced to change. He goes on to state that since I am Dr. X's patient that he would not step in the middle of a case or even the end of a case. It's unethical. He has the highest respect for my current Dr. and wouldn't take his patient away. He did try to contact the referring Dr. with out any luck at all. He wanted to find out why I was there. No charge since he didn't do anything. Meantime I'm still without a Dr. technically but my regular surgeon will continue to follow up with me and not leave me stranded. Still, I do need a referral to a plastic surgeon (same one that did my skin graft in April of 2008) to close my wound but my regular Dr technically cannot make that referral since he was illegally or at least unethically fired by AIG (my insurance co). I knew this would happen. It's really maddening!

 Wednesday, April 01, 2009 Finally some good news! Current mood: happy Category: Friends Today I have a follow up visit with my vascular surgeon. Too bad we spend more time talking about legal issues than medical. I took some pictures of my wound to take to him. He says things look great but I really need to get to a plastic surgeon for a skin graft. He calls the plastic surgeon right from the exam room and the plastic surgeon agrees to see me next week in his wound care clinic rather he gets paid or not. Wow, what great doctors! Then when I get home, I return a call to my attorney. Finally opposing consul has agreed to let my current surgeon continue the case and has agreed to the referral to the plastic surgeon. Praise God! My attorney is awesome. We've backed down opposing consul at every single objection they have raised.

Friday, April 03, 2009 The saga continues in a bad way Current mood: annoyed Category: Friends So, today I get a call from my attorney's office. Opposing consul now has yet another doctor for me to see presumably to take over from the surgeon I've been happy with for 2 years now. What a roller coaster ride this is and how inconvenient. This appointment will likely be like the last one if the Dr. is ethical at all. I'm really upset by this.

 Date: Apr 10, 2009 Plastic Surgeon and my non-healing wound Current mood: blessed Category: Friends Yesterday (April 9th) I had an appointment with the same plastic surgeon that did my skin graft last April. He says my wound looks good and we will continue on the wound vac therapy for another 3 to 4 weeks. At that time he estimates I will be ready for a skin graft. So probably early May and it will be back in the hospital one more time. Hopefully after the skin graft, it will take another 2 to 3 weeks for the swelling to go down on my stump and then I'll be walking again with my prosthesis and back on the road to rehabilitation! Nikko’s Mom provided the transpiration for this appointment. Thanks again, Angela. God loves you and so do I.

 Tuesday, April 14, 2009 Surgery Date Set Current mood: happy I got a call today from my plastic surgeons office. My skin graft is set for May 5th at 3:45 PM. I'll sure be glad to get this over with so I can get on with rehab and settlement of my workers comp case. When I received the call I inquired if there was any problem with authorization from AIG. The reply was "not so far". I see this Dr. in two days.

 Date: Apr 21, 2009 New Vascular Dr. ? Current mood: worried Category: Friends Well, yesterday I went to see this new vascular surgeon that opposing counsel arranged for me. He was very pleasant but misinformed. Right off the bat he talked of a bypass on my left leg!! There was never any surgery to my left leg prior to the amputation. During the consultation, he was more interested in my right leg than the left. Even had me take off my right shoe and sock so he could feel the petal pulse. Then he want and got a Doppler machine and listened to the pulse near the graft on my right side and the petal pulse area on my right foot. There was no talk of my open wound other than the date set for my skin graft. He never inquired about my daily Vancomycin infusions, nor my PT INR knowing I was on Coumadin if he read the notes I made on the initial paperwork to see this guy. He did say that it was not his intent to "steal" another doctor’s patient but he also said that he would be glad to follow me if my regular Dr couldn't see me. There is no follow up appointment. Strange.

Monday, May 04, 2009 Off to the Hospital - Opposing Counsel Loses again Current mood: happy Tomorrow I am off to the hospital for my 3:45 PM scheduled skin graft surgery. If all goes well, I should be home on Sunday the 10th and untethered from my portable wound vac that I've been wearing since my last surgery on March 3rd. Opposing counsel has lost another round. They sent me to yet a second vascular surgeon hoping for another Dr to take over my case. It backfired once again. He concluded my care had been proper and referred me back to my trusted vascular surgeon that's taken care of me for over 2 years now. Then, they finally got it right and have set an appointment with my rehab Dr. That one I will gladly keep!! They originally had scheduled an appointment for May 11 but there is no guarantee I'll be out of the hospital. I got a call from my attorney this morning. The appointment on 11th is canceled. No word right now as to the reschedule.

 Wednesday, May 13, 2009 Good Skin Graft Current mood: happy My operation to close my non-healing wound set for May 5th went off without a hitch. I did have a small scare while in the hospital. Plastic surgeon does the graft, taking a strip of skin one twelfth of an inch thick by about 1 inch wide and 4 inches long from the thigh of my right leg and closing the wound with staples, then applying a wound vac with strict instructions that it not be disturbed for any reason. On the second day after the operation, the wound vac failed!! It was time for a big panic. Loss of this machine for as little a 10 seconds can cause a skin graft to fail to take. The charge nurse came to the rescue almost immediately and a new wound vac pump was secured in place. I don't know how long we had lost the negative pressure for, but it seemed like under a minute. So, I was worried the entire time after that. But on the 5th day, the wound vac was removed and the Dr very pleased with the graft!! I am sent home and it sure feels good to sleep in my own bed after 5 days in the hospital. I will follow up on Thursdays in the wound care clinic and have daily dressing changed by the home health nurse. It also feels great to be untethered from my portable wound vac that was my constant companion for nearly two full months. Two days after being home my Vancomycin therapy is discontinued and my picc line is taken out. Hooray!! I really feel like I'm moving ahead again. I have an appointment next Monday, May 18th with my rehab Dr and I hope I can continue to progress under his care.

 Saturday, May 23, 2009 Rehab Dr, Wound Care & ARTHUR BLESSITT Current mood: inspired This past week I met with my rehab Dr. on Monday. According to opposing consul, he is my "Authorized Treating Physician". We talked and agreed that there is no vascular Dr in my treatment plan at the moment and so no one to officially clear my stump for weight bearing. We also agree that I see my regular vascular Dr. next week as a consult following an ultrasound on my graft on the right side. I will ask him off the record for permission to weight bear on my stump. He's really the only one that can make that call with certainty. On Thursday I saw my skin graft Dr in the wound care center. He cleared me to shower and do my own home health care on the graft side - just keep some clean gauze on it and change daily. He cleared me to shower and did it ever feel good. I wasted no time in showering when I got home. The highlight of my week can be found in the following email exchange with one of my true heroes,

ARTHUR BLESSITT. Praise God! wrote: Ralph Zimmerman sent a message using the contact form at Dear Rev Blessitt, I remember praying with you in an open-air rally at Bayfront Park in Miami FL sometime in the early 1970's. It changed my life and I am grateful. I'm trying to nail down the date for a book I am writing. Could you please help me? Thank you. God loves you and so do I. Ralph Zimmerman Arthur Blessitt wrote: Thanks, yes that was in the early 70's. So thrilled your life was changed there. I even have photos of that meeting somewhere. Not sure of the year or date but have it somewhere I'm sure. Blessing on you and the book. God bless you, Arthur It would take some time and effort to get that and with the movie "The Cross" time is hard to come by at the moment. Praying for you, arthur For where "The Cross" film is playing go to: www.thecrossfilm.com Click on theaters, For all other 'Cross' news and DVD news go to the link above. God bless you Arthur and Denise Blessitt Luke 18:1 www.blessitt.com www.8x.com > >> arthur@blessitt.com > >> "The Cross" the movie in theaters NOW across America. > >> "The Cross" the book in bookstores and online, Now! > >> Arthur Blessitt > >> P. O. Box 201840 > >> Denver, Colorado 80220 > >> U.S.A. > >> On May 15, 2009, at 10:50 AM, ralph_az@yahoo.com Dear Arthur, Thank you so very much for the quick reply. I've followed your ministry for a long time now. It's disciples like you, Dr. Robert Schuller and Billy Graham that give so much to the world and has saved so many. God bless you always for the work you do for Jesus! On the date, as close as I can come is 1970. After your walk across America and before you left for England to start your world crusade. I'm exited about your movie!! And all that you do. Thanks again and may the Peace of Jesus Christ be with you always. Ralph Zimmerman Arthur Blessitt wrote: I will look and find the date for you. arthur Thank you, Arthur. You're one of my real heroes. Very briefly I want you to know precisely how praying with you changed my life. I grew up in the Methodist Church and had a good relationship with Jesus. Bad decisions, bad luck and a defiant young man in my early 20's found me homeless in Miami and down and out. I had strayed from my fundamental values and turned my back on God for whatever reasons I cannot comprehend at my age of 65 now. Praying with you opened my heart, soul, and mind so that I could turn once again to Jesus. I heard God whisper to me with a plan and a very short time later I got a job that I stayed at for 7 years and completely turned my life around. Praise God and you! I cannot thank you enough! Yours in Christ, Ralph Arthur Blessitt wrote: The date was January 20, 1974 I had a beard and was back from Africa for a couple of months. I talked with Bob Dylan at that meeting. That is in my diary. Can't find that I spoke at the park earlier. Praise God, Blessitt Thank you so very much for researching that date. It fits perfectly. I've been having trouble with the order of events in the 70's and that clears everything up for me. I know you are very busy and I appreciate your time on this. I did not recall Bob Dylan being there but I do remember you sporting a beard and very interesting is the fact that Bob Dylan's real name is Robert Zimmerman! We share the same last name and first initial. Praise God! He was up to something that day for sure and I was part of it. Thank you again and may God continue to bless you in all that you do for Jesus and bringing The Cross to all of us who need it. Can't wait so see the movie. Ralph Thrilled you got the date. Praying for you and God bless you, Arthur, Denise & Sophia Blessitt Luke 18:1 E-Mail arthur@blessitt.com Website: www.blessitt.com "The Cross" the movie out now in theaters in America. Check for theaters at: www.thecrossfilm.com For news about the DVD check there also. "The Cross" the book out now! Arthur and Denise Blessitt P. O. Box 201840 Denver, Colorado 80220

 Date: May 29, 2009 Healed Skin Graft & Nikko's Surgery Current mood: happy Yesterday I saw my Plastic Surgeon at the Wound Care Center. He says my skin graft is completely healed!! Praise God! I am also, from his perspective, able to resume rehab and weight bear on my left residual limb. His notes also will state that I should be seen by the vascular Dr who did my surgery on my left side (same Dr that referred me to the Plastic Surgeon and the same Dr that the workers comp insurance is mad at) before resuming rehab. I see my Rehab Dr on Monday June 1st so we'll see what he has to say. Nikko had some outpatient surgery today. An abnormal bone growth shooting out from his tibia. Surgery went well and he's home recovering. He was happy that I was there for him as was his Mom. And of course I was thrilled to be there for him. He calls me his best friend and I am honored. This past Tuesday I had an ultrasound on my right leg and graft along with pressure tests. From the technicians point of view all was well but of course the official word will come from the Dr. I was hoping to see him on Wednesday, the day after the tests but his office called me Tuesday and rescheduled my appointment with him until June 10th. They say the hospital does not get the results to the Dr.'s office soon enough. I was hoping to see him before I see my rehab Dr. for an off the record clearance to weight bear on my stump. That's still up in the air. Damn the opposing counsel!

 Date: Jun 2, 2009 Lots happening - I can see the finish line! Current mood: anxious Last Thursday my plastic surgeon said it was OK to weight bear on my stump so long as the stump was good but that it really was my vascular surgeons call. Well, my insurance company is mad at my vascular Dr. and has failed to hook me up with another one, I made the call myself. It has been since February 10th that the major surgery was done and then early March for the surgery to prepare the non-healing wound for a skin graft. My stump feels good. So, on Saturday I put on my prosthesis and started waling with my walker. I was surprised at how well it fit, although there may be an issue toward the very end of the stump. Anyway, I walked for a half-hour around the house and took it off looking for any sore spots. There were none. I did the same on Sunday but a little longer and I walked up and down my ramp once. All was well after the second session. On Monday June 1st I had an appointment with my Rehab Dr. I wore my prosthesis and used my walker to go to this appointment. The Dr is referring me to final rehab. He asked me to fax the last two operative reports from my vascular Dr, which I did when I got home. He also had the report from the vascular Dr. that the insurance company referred me to in April. Opposing counsel has set an appointment in Denver on July 1st for an independent medical examination. My attorney is also setting an appointment with their independent medical examiner. My case will settle when I have reached maximum medical improvement regardless of further prosthetic needs. So, we're probably a few months away now. My attorney also said yesterday that they were filing for an expedited hearing to address the issue with my vascular Dr and continued monitoring of my PT/INR (Coumadin level in my blood). So, it seems like there is lots going on. We'll see if the insurance company authorized continued rehab now. Also there is the issue of the "C-Leg" which everyone says I'll need. The prescription for that can't be written according to my rehab Dr. until I demonstrate that I am fully up on the prosthesis I have now.

 Date: Jun 13, 2009 Getting Closer! Current mood: happy This past week I had an appointment with another rehab Dr. This one, set up by my attorney with the hope of reaching a determination of Maximum Medical Improvement. As soon as he learned that my vascular Dr. had not yet cleared my stump for weight bearing the visit was pretty much over with. That appointment was on Monday. Then on Wednesday I had an appointment with my vascular Dr. and he has now cleared my stump for weight bearing. Good news!! I have an appointment Monday morning with my Rehab Dr. and Monday afternoon for a formal rehab evaluation. I've been walking again with my prosthesis and walker and it feels good!

Date: Jun 18, 2009 A random act of kindness and discharge from wound care Current mood: happy The other day I went though the drive-thru at Wendy's on my scooter. The guy ahead of me saw me in his rear view mirror and saw my stump. When I got to the pay window I was told the guy ahead of me bought my lunch!! There are great people in this world. I am now officially back in rehab with no objections from my insurance company. They are sending me to Denver on July the 1st for an independent medical examination, which should be a step closer to the finish line and settlement. I've been poor now for so long that settlement means more than total rehab. Today I was discharged from wound care. My skin graft donor site has healed finally and the graft was good several weeks ago.

 Date: Jun 24, 2009 Rehab is harder this time around - Turning 65 sucks! Current mood: blessed Today was my second rehab session. In one way I am very pleased with my progress. Weight bearing is neither difficult nor extremely painful but it does hurt some. My leg muscles are very sore on both sides after a good workout. I was able to walk with one hand quite well on the parallel bars. On the other side of the coin, I do not feel stable on my current prosthesis. Seems like I have to think about every single step and as soon as I let my mind wander a bit or not pay strict attention I am destined for insatiability or forget to do something right which creates poor posture and bad walking. Also, wearing my prosthesis about the house and using my walker makes carrying a cup of coffee or dinner from the kitchen to a place to eat difficult and prone to spills. I hope things get better. I did turn 65 on the 6th of June. Mentally I still feel 30ish but I sure wish I were physically better. My Social Security check, which used to be $1104 a month is now just $1008. The difference of $96 is for Medicare. My prescription drugs now cost a little more. I still am poor enough for Medicaid and have both Medicaid and Medicare, but I make too much with my whopping $388 a month in disability to get help with my Medicare costs. I will be very anxious to get my case settled so I can go back to work if I can find something I can do that I enjoy. I'd love to go back to what I was doing when I lost my leg but it will require a different knee than what I have now. I'm sure the insurance company will choke at a prescription for a computerized "C-Leg" which start at about $40,000. That's probably what I will need for stability to return to delivering pizzas and climbing stairs and walking on uneven ground in unfamiliar situations. I also want to visit other amputees to let them know that there is a light at the end of the tunnel. Two amputees visited me while I was in the hospital right after my amputation. They were a huge inspiration.

 Date: Jun 29, 2009 Another Independent Medical Examination Current mood: sore I've had a few days off from therapy but back at it tomorrow. It's harder this time around as I've been wheelchair bound for 6 months again. Wednesday July 1st my attorney is sending a car for me to travel to Denver. Opposing counsel has arranged an independent medical examination with their Dr. It'll be a nice half-day outing and one step closer to settlement. The key to settlement is DR’s agreeing that I have reach maximum medical improvement, notwithstanding continued rehab and prosthesis care.

 Date: Jul 1, 2009 Opposing Counsel Cancels plus definition of Maximum Medical Improvement Current mood: okay Well, yesterday while I was at rehab, my attorney called and left a message. Opposing counsel had canceled my appointment with their Independent Medical Examiner in Denver which had been set for today at noon. We're not reading anything into this right now but it just seems strange. As I started out the door to go do some grocery shopping on my scooter about 10:15 am, there was a car in my driveway to take me to Denver. Seems as though counsel forgot to cancel the transportation! Also I had gotten a call on Monday from Interim Health Care. They've been talking with AIG and they will continue to pay to have a nurse come to home to check my PT/INR, which is necessary every two weeks, because I am on long-term Coumadin (powerful blood thinner) therapy. This is good news since my original vascular surgeon (the one they are mad at) wrote the order and is monitoring the result. Back on June the 9th my attorney sent me for a case review by a rehab Dr. He said the same as every other Dr - that I need to get back with my vascular surgeon to get the stump released for continued rehab. He states "I doubt anyone else from a surgical perspective will walk in the middle of this case and take over his case. Surgeons usually don't work that was." Of course they next day I saw my vascular Dr. and he cleared the stump for weight bearing and continued rehab. However, this opinion was secondary to the reason I was seeing him on this date. We were reviewing the studies done on my right side to make sure that graft was flowing well and it is. My case will settle when I reach maximum medical improvement. So, for what it's worth, here is the definition from the Colorado Revised Statutes: "Maximum medical improvement" means a point in time when any medically determinable physical or mental impairment as a result of injury has become stable and when no further treatment is reasonably expected to improve the condition. The requirement for future medical maintenance which will not significantly improve the condition or the possibility of improvement or deterioration resulting from the passage of time shall not affect a finding of maximum medical improvement. The possibility of improvement or deterioration resulting from the passage of time alone shall not affect a finding of maximum medical improvement. Date: Jul 5, 2009 Examination with IME has been reset. Current mood: happy A letter received from my attorney on Sat confirmed the cancellation of the appointment in Denver. It has now been reset with a similar type of Independent Medical Examiner Dr. for July 29th here in Colorado Springs. Things are going well. I've had some new pain in the end of my stump. Could be a fit issue. I'm experimenting with different socks to see if I can get some relief. During my last rehab session, I did some walking again with a 4-point cane. I was still between the parallel bars for safety and my form was far from perfect but I was able to do it. I was quite happy with that, since that was only my 3rd rehab session after having been off my prosthesis for nearly 6 months! Praise God!

Date: Jul 16, 2009 Good rehab! Current mood: happy I walked about 60 feet today with a 4-point cane!! Also able to walk with my walker in a continuous walk instead of take a step and stop. So, I am making some progress and it feels good. I do have some different pain in the end of the stump this time around when I am doing the exercises they want me to do, but mostly pain free when walking! All else is well.

 Monday, July 20, 2009 Good news and bad from my Rehab doctor Current mood: happy I had an appointment and assessment from my rehab Dr. today. We had a very frank discussion on where I am at and where I am to be. Due to the last 3 surgeries on my stump side, the last one being a skin graft to cover a non-healing wound, my Dr. feels like I will never be able to walk correctly without the use of some mobility device, be it my walker or a 4 point cane. The surgeries in the groin area are limiting my ability to extend my leg backward properly and hence hinder my ability to achieve a proper gait. He said I will for sure never be able to go back to delivering pizzas. Delivering pizzas is nothing more than normal living but where I would not be able to perform would be a delivery that required me to climb stairs with pizzas in one hand and a bag of extras such as 2 liter bottles of pop. Plus the challenge of uneven ground at various delivery situations. Well, I can accept that I guess. The limited mobility will greatly increase my settlement amount so that's the good news. Other good news is lifetime medical care for both the right side of my body (stump, prosthesis care and replacement, vascular issues to the stump etc.). Also, all hardware is covered for life, meaning my scooter, wheelchair, walker etc and should I ever move, any home modifications that would be required are covered. Also because I have contracted bilateral carpal tunnel syndrome on both my hands from wheeling in the chair too long that I will have lifetime medical and surgical coverage there. So, the good the bad and the ugly!! Actually, today my leg worked very well for me and felt comfortable with very little pain. For the 1st time, I am now able to walk in a continuous motion, instead of taking a step and stop with my walker providing I had a smooth surface.

 Date: Jul 28, 2009 Maybe some good news Current mood: excited Category: Goals, Plans, and Hopes I've received a copy of my rehab Dr.’s latest progress report. In spite of, or in addition to what he told me, he has written in his report "Therapy has recommended an additional six weeks with anticipation that he will be able to advance to another prosthesis, possibly compact, a C-leg version, that will allow for further improvement." It's good to know that my prognosis is good!

 Thursday, July 30, 2009 Independent Medical Examination Current mood: happy Category: Life Yesterday I went for an IME (independent Medical Examination) with a Dr arranged by opposing counsel. Before beginning, he asked me to sign a form explaining the procedure, which stated among other things that "After the interview, there will be a physical examination." The interview part was mostly concerning what happened on the date of my injury and the treatment and Dr.'s seen between the accident and the loss of my leg. In a sense it was good since I had the opportunity to tell exactly what happed including my employers lack of concern for my injury - keeping me working for two weeks after the injury until I could stand the pain no more and their failure to send me for medical treatment. Also one Dr. had said the accident occurred while I was going upstairs when in fact I missed a step that was 6 to 8 inched down. It was an opportunity to correct this. It did not seem that he had any recent medical records. Toward the end of the interview, I asked him if he thought I was at Maximum Medical Improvement. He said that to make that determination he would have to review my records from Rehab, what goals they had for me and what my progress was. I wore my prosthesis for this meeting and of course had to use my walker. He did watch me walk as I left his office without any comment. There was no physical examination of my stump, nor the graft area of my groin, which seems to limit the backward swing of my stump. According to the information sheet that was given to me the Dr. has been asked to "...write a report answering specific questions that the requester has asked." I'd love to know what those questions were.

 Date: Aug 3, 2009 Good Rehab - 4 point cane Current mood: excited In rehab today my walker has been discarded and I am only allowed to walk with a 4-point cane. So, after getting my stump stretched. in a total of 3 different walking segments I did walk a total of 254 feet with a 4 point cane!! Not perfect form, mind you but I did it and so my confidence level is quite high right now. I am told that I have 6 weeks to get up on the 4-point cane and walk 1500 feet. If I can't at the end of 6 weeks that will be the end. If I can, then I will be considered a candidate for a more advanced knee and lower leg, possibly a compact C-leg by OttoBach. When I came home today, I did some (quite limited) walking with a 4-point cane and had to stop. I had enough for one day and my stump was a little sore. The key will be my increased use at home. Living alone, I need to be careful. I'm, not nearly as stable as I am in rehab with my therapist with me every step of the way. I feel good about my progress today.

 Date: Aug 8, 2009 Ups and Downs with mobility aids Current mood: bummed My second rehab session of the week was on Wednesday the 5th. I was able to walk about 320 feet this time with the 4-point cane and I was feeling good until I got home. I had vowed that I would as much as possible eliminate the use of my wheelchair at home and use my walker as much as possible and practice with the 4-point cane. All was well until it came time to do a load of laundry. I could not carry a laundry basket full of clothes with my walker let alone a 4-point cane. Simply much too awkward even with the walker. So, to take care of my laundry I had to go back to the wheelchair. I thought I was OK again until it came time to prepare dinner. Very very awkward and cumbersome from the walker. My prosthetic foot keeps getting caught under the lower cabinets in my kitchen and did not allow for quick moving from refrigerator to stove to prep area etc. Much more efficient and safer from the wheelchair. When I view my experience along side the statement that my rehab Dr made to me last visit when he said I would probably need a mobility device the rest of my life and that I would never be able to back to work doing what I did for well over 20 years I am quite bummed out. Then there is the issue of pain that I've been complaining about since my last surgeries. There is a huge spot of my stump that is now numb to peripheral touch. When I asked my vascular surgeon about it, he said it was probably due to an irritated nerve. OK, that's not too bothersome but along with it and since my last surgeries, I have fleeting sharp pains along the top of the end of the stump. I went to my prosthetist and he didn't feel that any adjustment of the prosthesis was in order. It bothers me least when trying to walk but then I am not putting full weight on the prosthetic limb for fear of the pain. The prosthetist said he would be glad to attend a rehab session with me to see if he could help pinpoint the reason for the pain and my therapist said it was unnecessary. There has been a time or two that the pain occurred while I was trying to walk and I think subconsciously is limiting my ability to put all my weight on my prosthetic side. I am also told that I have to be able to walk 1500 feet on a 4-point cane in 5 weeks or that will be the end and no further advanced knee will be considered. That 1500 feet right now seems impossible. As well as just normal day to day things like carrying a dinner plate and beverage from the kitchen to eating area, making my bed, doing laundry, shopping etc. One thing that bothers me is that everything I've read says that if it hurts to wear it, it's not fitting right. Yet my rehab Dr (who has been designated as my "Authorized Treating Physician"), my prosthetist and my therapist don't seem to want to address it as a team. Next month I go back to see my vascular surgeon (whom I understand has been reinstated by my insurance company) and I will ask him for a referral back to a pain specialist if no one else will help me in the meantime.

 Monday, August 10, 2009 Severe pain and no sleep Current mood: annoyed On Saturday I wrote some about pain issues so perhaps I was having a premonition of sorts. I hope not, but: It started Saturday afternoon. Severe phantom limb pain that when it hit was a solid 10 on a scale of 1 to 10. It felt like a nail was being jammed into the heel of the limb that I have no longer. It lasted only a few seconds and by putting my stump in high-speed motion, it would go away. Now this is not so bad except that on this day, by time I was ready for bed the waves of pain were occurring about every 10 minutes and did not let up all night. I tossed and turned, trying to sleep only to be awaked by the horrible pain. Sometimes it would seem like the top of my foot near my toes was being attacked by the same nail. By time morning came I was exhausted but I dragged myself out of bed anyway. The pain kept coming but now not as often. Sunday gave me a few hours of relief but it came back again in the middle of the afternoon. I put my gel liner on so see if that would help. It did help some so far as the frequency of occurrence but the pain was there nonetheless. Still exhausted from no sleep, I went to bed about 5 PM, watched the news and 60 minutes with waves of pain still there. About 8 PM I took my liner off and the pain was still there but by now maybe only once every half-hour or so. I took two Percoset and a sleeping pill and I managed to fall asleep. When I got up this morning I felt quite rested and so far today, I have no pain. This pain was much different from the pain I had last year in Aug/Sept. That pain only occurred when I was trying to walk and then only when I was pulling back off my prosthesis. Three sots on the back two weeks apart took care of that and I still do not get that same pain back.. Well, it is what it is. It prevented my from walking altogether Sat and Sun but I did get some waling in Friday afternoon and evening at home. I will talk with my therapist today, praying that the pain will not return so I can get benefit from therapy. I want so badly to get up and walk on my prosthetic leg with a 4-point cane or no cane at all so I can feel like a half way normal human being again. This has all gone on much too long.

 Date: Aug 15, 2009 4-point cane is tough with prosthesis Current mood: disappointed In two separate physical therapy sessions this week, I was pushed to my physical limits using the 4-point cane. I think the furthest I was able to walk with out a sit down break was around 160 feet. I am still getting pain that is preventing me from putting my full weight on my prosthetic leg. Also muscles in the thighs of both legs get fatigued sooner than I feel they should. Too much down time earlier in the year, I guess and it's a much slower process now than I had hoped. That 1500-foot goal seems out of reach given the current set of circumstances. I've discussed things at length with my family doctor and he agrees with me that the key to my long term strengthening of my limbs and progress will be after my case settles and I can get a car again and then start being much more mobile than I am now. I have an appointment with my prosthetist this next Tuesday. Hopefully he will have a solution to my pain issue if it is a fit problem. My bilateral carpal tunnel syndrome that has set in since wheeling in the wheelchair for so long is being aggravated now by my extensive use of my walker. My hands are very sore and I have an appointment Monday afternoon with my hand surgeon for more cortisone shots in my wrists. It lasted for quite a long time after the first set of shots, so I am hoping for some relief.

Date: Aug 15, 2009 Samantha is gone. Current mood: blessed My very good friend Samantha and her kids are pretty much gone out of my life. She left early in July with her kids in a used car that was new to her. They drove across county to somewhere in Indiana I think to meet her "internet family". I haven't heard from her but I get news from her ex boyfriend. I guess the car blew up so she got stuck there and won’t be coming back to live in her old house. I will miss her very much and now have to rethink a big part of my life. She had been my emergency contact in hospital and doctor records and her and the kids figured prominently in my will, with her to be my personal representative. I have always viewed Samantha as one of the angels I have known as she has never let me down. As a practical matter that will have to be changed. This past week, Nikko's mom, her boyfriend, Nikko and I went on a summer's end picnic that was delightful. I had a chance to talk with his mom and she agreed to be my emergency contact as well as my personal representative if something should happen to me so long as I had my living will in place. So that is a big relief. Thank you Angela, another angel I see walking the earth.

 Date: Aug 17, 2009 Settlement? and 460' Current mood: excited Today in physical therapy I walked a total of 460' with my 4-point cane in 3 different walks. The longest was 194'. It still hurts and I do not feel stable BUT I was able to do it. On a nice surface with no obstacles except having to turn. My rehab Dr still feels that a better knee is needed and that I have some definite fit issues. Going to see my prosthetist tomorrow, When I got home there was a message to return a call to my attorney (actually the paralegal). Seems like the insurance company and opposing counsel want to talk SETTLEMENT!! I have no idea if it's the right thing to do, especially since there are a lot of remaining issues such as a better knee, my carpal tunnel syndrome and the fact that NO Dr. to my knowledge has said that I am at maximum medical improvement. . I said I'd be willing to talk so a meeting will be set up with the actual attorney. So, maybe good news, maybe not. Time will tell.

Date: Aug 19, 2009 Prosthetist puzzled Current mood: aggravated Yesterday I spent some time with my prosthetist trying to figure out the pain I am having on the end of my stump when I first get up from sitting or when first putting on my prosthesis. He's a little puzzled, thinking it may be a nerve issue (only happens since my last surgeries in the spring) but has asked my rehab Dr for a script to do a test clear copy of my current socket so he can see exactly what may be wrong with the fit.. I continue to get on and off my mobility bus without the lift so long as someone can handle my walker. I need to learn how to do that by myself. It's fun to make progress. The 4-point cane is coming much slower. Limited mostly by simple fatigue and not being able to put full weight on my prosthetic side. I do not feel comfortable practicing the 4-point cane at home. My carpet is soft and presents an instant wobble as soon as I get up on it. Much different than the smooth and hard indoor/outdoor like carpet at rehab where I get a solid surface for the cane. They are pushing me to learn and be comfortable with it faster that my body wants to.

 Thursday, August 20, 2009 Still sore on stump. Current mood: annoyed I am still getting pain at the end of my stump on the top inside portion. It very much limited my rehab session today as I could not walk well at all without a lot of pain. We terminated the session early.

 Date: Aug 29, 2009 Poor progress Current mood: okay This past week had two physical therapy sessions and both were disappointing. I am able to walk less and not more each session. Seems like the more I try to put all of my weight on my prosthetic side while trying to use the 4 point cane the more pain I feel on the end of my stump. I've been to my prosthetist and he wants to do a duplicate socket in clear material so he can see exactly what is going on when I put my leg on. This requires a prescription from my rehab dr. and he wrote it without hesitation. So, I'm waiting to hear something since the next step is getting authorization from AIG ( worker's comp insurance co). I haven't heard anything so on Thursday past I called the office of my prosthetist and no one knew anything. The main man was away for the week so I was told that I would probably hear something on Monday coming.. Everything takes so long that it tries ones patience. This coming Monday I have an appointment with my rehab dr. and I am going to ask him for a referral to the pain dr. that gave me three shots in the back last year that took care of the pain I was having on the bottom of the stump when on my prosthesis and coming up off it while walking. I figure it's worth a consult and prudent to be working in parallel with my prosthetist in case it's not a fit issue.

 Date: Aug 31, 2009 Going Backwards & other obstacles Current mood: bummed Seems like the more that I try to weight bear on my prosthetic leg, the more it hurts. I've been experimenting with different ply socks (they go between the gel liner and the rigid socket to make up for volume changes in the stump) trying to sock the pain away but less than a 5 ply and I have constant pain. A 5 ply is best. Today was an absolute disaster in rehab. I could not walk at all with the 4-point cane without severe pain. Before my rehab session today, I had an appointment with my rehab dr. He's disappointed that my prosthetist is taking so long to troubleshoot my fit/pain issues. I called the prosthetist's office today and they had no word at all. Said they'd check if the duplicating material is in and call me later today. It's been 2 weeks tomorrow. Through all of this I'm quite bummed out. When they took my leg off, it was thought that I would be a good candidate for a prosthetic limb. Early on I was told that the OttoBock C-Leg would allow me to go back to what I was doing. My rehab dr. now says that won't happen. That I will probably need an assisted device of some sort no matter what. A 4 point cane or a walker. He still wants me to have a better knee that what I have know and is willing to work past the pain issues with me. He gave me a prescription today for a x-ray of my stump to see if there are any bone spurs or cartilage issues on the distal side of my stump causing pain. I will have the x-ray done on Sept 3rd when I go back for my next rehab session. If fit issues don't help then he will refer me back to the pain dr. that gave me relief before (pain on the bottom of the stump as I was pulling up off my prosthesis) with 3 shots in the back two weeks apart each.

 Date: Sep 3, 2009 Still going backwards!! Current mood: blah Another rehab session today was a disaster - could hardly walk at all with the 4-point cane and now hurting more even with the walker. My last session of rehab has been canceled. There likely will be no more. I know what to do and have been taught well. I simply cannot execute properly or at all due to the pain. I never had this before the 4 point cane rehab started. I did get my stump x-ray today and tomorrow I finally have an appointment with my prosthetist so I am hopeful. I was discharged from home nursing today and will now have to go to a lab weekly or bi-weekly to have my PT/INR checked as I am on long term Coumadin therapy to prevent further blood clots.

 Date: Sep 5, 2009 The source of the pain? Yesterday I had a lengthy session with my prosthetist. We looked at the area the pain was coming from and using some tape and lipstick (that's right), he matched up the spot on my socket and then proceeded to blow it out a little to give me more room. This gave me a comfort zone that was helpful when walking with my walker and taking short steps on my prosthetic limb. However, when extending my left leg (prosthetic) I still got a pain as I did a heel strike to take a step and the same thing when my prosthetic was far back in the gait cycle. Just a short burst of pain in both instances. Also I was able to feel something moving in the stump as I worked past the pain. It was like cartilage rolling over a bone. Prosthetist says he's seen this before and it's like a loose tendon. Question now is what do we do about it? I'll have to let my rehab Dr. know on my next appointment on the 14th. My prosthetist is in agreement with me that a consult with the pain Dr. I used before would be useful. I also see my vascular surgeon again on the 16th. Perhaps he might have a recommendation. In the past he has always know just the right Dr. to send me to.

 Date: Sep 14, 2009 Slow progress Current mood: annoyed I had an appointment today with my rehab Dr. With a physical examination of my stump he was more able to pinpoint the source of my pain. A referral back to the pain Dr. is now in the works. I'll have to wait to hear from the pain Dr after he receives the referral info for an appointment. Meanwhile, my workers compensation check that cycled on Aug 29th is missing in action. I received it on Sept 1st and mailed it to my bank the next day in their business reply envelope the same as I have been doing for over a year now. As of today, it still has not posted to my account. So, either it is lost in the postal vacuum or the bank received it and posted to the wrong account by mistake. After talking with my bank, I faxed all the info to my attorney on Sept 10th and have yet to hear a word. The bank recommended a stop payment and a new check. Problem is, I have to go through my attorney and cannot have any direct contact with the insurance company. They in turn have to notify opposing consul, and on and on. I'm bummed since I have not heard a word from my attorney. If the check cleared and posted to the wrong account I will still need a copy of the back of the check or some affidavit to prod my bank into looking for their error. Seems like if the check is lost that the other side would want some sort of signed document as to what happened before they issued a stop payment and issue a new check. Things work much too slow in this area. I really need the ,money and I sit waiting for the wheels to turn. Oh well, it's out of my hands so I have to be patient but it isn't easy!

Date: Sep 16, 2009 Arteries are clear and check is found Current mood: blessed Office visit today with my vascular surgeon to review the results of the ultrasound studies taken last week. There are no vascular issues in my lower extremities and I won't need to see him for 6 months. He agrees that a referral to the pain Dr is a good plan, also for a better knee. I felt good leaving his office with good news. Also when I checked my bank account today, the missing deposit got posted yesterday. BIG relief but I sure wonder where it was for 2 weeks! Date: Sep 17, 2009 Injections on the horizon!!! Current mood: excited Pain Dr.’s nurse called this morning and I am set for my first injection for my current stump pain on Monday the 21st! Oh Happy Day!

Date: Sep 21, 2009 Pain Dr FINALLY! Current mood: grateful I had an appointment today with my pain Dr. who also is the chief anesthesiologist for a major hospital here. We looked at the physical spot on the stump where the pain was coming from. It's bundle of nerves. Using Diprovan as the drug of choice he was able to put me under to the point where I knew nothing but was still able to talk to him. That way he could e certain he had the steroid needle in the right spot for the injection. I woke up, not remembering anything of the procedure with a band-aid on my stump. I'm resting it today but will put me prosthesis on tomorrow to go to my settlement appointment with my attorney. For the moment, however, physical handling of the stump is paining free when pushing at the area that had been causing me pain. So, it appears that I have initial relief. Good test tomorrow when weight bearing on my stump with prosthesis on.

 Date: Sep 22, 2009 No settlement yet! Current mood: okay I met with my attorney today as scheduled. I actually met with my paralegal and the newest member of the law firm and not the one who "is respected for her extensive experience as a workers’ compensation trial lawyer, having obtained large sums of money and other benefits for those injured on the job" (according to the firm profile on their website). I'm certain that this newer member is competent or he would not be with the firm and I know that she is still over seeing my case. After all, this was just very preliminary. Come to find out, there was no solid offer on the table. Only an inquiry from the other side to see if we wanted to settle. Advisement from the attorney was to stay the course until I have reached MMI (maximum medical improvement). I was hoping that we'd have a hint as to where the other side stood on things. Oh well. With regards to reaching MMI, I received in the mail today the latest report filed by my rehab Dr. In the report under "Treatment Plan" he states that "At this point plan is likely for control of this pain issue followed by consideration for MMI. And in the report he references my bilateral carpal tunnel syndrome by saying that consideration for surgical treatment is inhibited by my need to use a walker. My prosthesis felt good today and preliminary weight bearing was good. I was supposed to set an appointment with my rehab Dr. after getting my pain shot. I called today and his first available is not until October 12th. So I have some time to try my best to get up on this prosthesis.

 Date: Oct 5, 2009 Something still not right. Current mood: hopeful Well, the shot in my stump to relieve the pain that was being caused by an active bundle of nerves (neuroma) has helped a lot. I used to get a pain type sensation that ran down the inside part of my stump when I stood to urinate. That pain also is gone now. So far as walking with my prosthesis, it is now generally much less painful, but not pain free. I still have an occasional pain along the outside part of the end of my stump where the skin and muscle are thin and one can plainly see the end of my femur. I've done some research on the web and it seems that the solution to a final comfortable fit is to add layers of socks. I've experimented some with this and have had some success. I have been using one five-ply sock with one one-ply sock with some success (total of 6). I think now I have to add another one-ply sock for a total of seven. I might try two three-ply socks with one one-ply sock. Anyway way you cut it it's a pain in the neck (or stump as the case may be!). I have a lot of extra room at the top of my socket where my stump has changed volume. When adding socks to relieve pain at the end, there is some tightness in the middle of the stump in the socket, which makes my muscles sore hence limits, my ability for long term use. I am anxious to settle my case but not so as to cut my care short. At this point, I really think a new socket, properly casted will solve my current problems. I still feel very unsafe as well as some pain when trying to weight bear on my prosthetic and attempt a four point cane. I still do not feel safe trying the cane at home by myself. Perhaps another sock will make a difference. I will make every attempt to try adding another sock before I see my rehab Dr. again on the 12th of October - one week from today.

Date: Oct 7, 2009 Very strange rash appears along with great pain. Current mood: optimistic I'm a little behind in documenting this strange condition. Starting on Friday Sept 25th, 2009, my right lower leg started showing small blotches and some soreness. It continued on into Saturday when it became much more widespread and affected my lower limb from about 1 inch above my failed fem-pop bypass graft down the inside of my leg, angle and foot. It became so sore that late Saturday evening it was extremely painful to stand on my right leg, with most of the pain being felt along my Achilles tendon. I was a heartbeat away from going to the ER on Sunday but I did not want to spoil a good weekend with my best buddy Nikko who looks forward to spending weekends here with much joy, so I decided that if it was not better on Monday than the slight improvement that I had on Sunday, I would go to the ER then. I prayed a lot! As it turned out, Monday the 28th showed marked improvement and so I decided simply to just rest the leg and foot and keep it elevated as much as possible. By Thursday it was all cleared up and I once again had full use of the leg so I could get back up on my prosthesis. I've posted two pictures of my lower right leg taken on Saturday the 26th about 6 PM. It was not the worst it was going to look. The URL to the picture page is embedded in the description below. Rash and other nasty pictures. I might add that along with the rash was elevated temperature in the area of the rash. It literally felt like it was on fire to the touch compared with the temperature of my calf on the same leg. Very very strange indeed.

 Date: Oct 12, 2009 Rehab Dr. sees need for new socket Current mood: hopeful My appointment today with my rehab Dr. confirmed what I have really felt for some time now - I need a new socket. The constant repositioning of the stump in the socket after walking for awhile is a huge clue and I've been complaining about that for at least 4 months, mostly to my therapist. Also, after sitting for awhile and standing again, I have to sink my stump down in the socket again. My Dr. put in a call to the prosthetist who was out to lunch but left a message, He also wrote me a script for the socket. We agreed that I should wait two days and call the prosthetist on Wed for an appointment. Then after the new socket is obtained, to call the rehab Dr. for an appointment at which time he will most likely find me at MMI and outline a long term care plan for future prosthetic needs etc. There may be a fight with insurance for authorization of this. We also discussed the IME (Independent Medical Examiners) report that opposing consul had arranged Aug 29th. Rehab Dr. says the report is trying to reach a conclusion that all of my care is not related to my missed step on June 21, 2007. Seems a little late since the insurance company admitted liability in December of 2007. None the less, they now have some biased ammunition to argue with. The fact still remains that if I did not have the missed step injury, I would still have my left leg, On may 9, 2007 Dr. Carlson explained to me that I "certainly had options for revascularization with endovascular options on the left but the right side would require major bypass." This is in the IME's report and is consistent with everything I have said concerning my injury on June 21, 2007. There was nothing limb threatening on the left side prior to my injury.

New Socket in the wind? Current mood:  anxious Well, I met yesterday with my prosthetist. He had spoken to my rehab Dr. who is also my Authorized Treating Physician according to my insurance company since they fired my vascular surgeon last April. My prosthetist measured my stump at many different places and compared the measurement to the ones taken for my current socket. There has been a definite change and he is also recommending a new socket. So, the proper paperwork has been faxed to the insurance adjuster and so now I'm just hanging out waiting for a call that it's been approved. I had notified my attorney about this upcoming  need so they are prepared to fight if necessary and I called this morning to give an update. I'm due to go to the Outpatient Lab at the Hospital for a check on my PT/INR Wednesday or Thursday. Probably going to be Thursday morning since there is snow in the forecast for tonight into tomorrow which is Wednesday. At least I get out of the house and plenty of friends to visit at the hospital.

Date: Oct 22, 2009

Date: Oct 28, 2009

Approval for new socket finally! Current mood:  excited On the 4th, just two days ago and after what I am sure was much prodding from all that could (Rehab Dr., attorney, prosthetist) my workers comp insurance company adjuster finally gave approval fro my much needed new socket. Yeah! I go to the prosthetist on Nov 11th (Veterans Day) for my casting. I'm stoked because this should be the last piece of the puzzle for me to be found at MMI and start to work on settling my case. I's so excited and anxious, I can hardly stand it! Yesterday, Nov 5th, would have been Denver's 46th birthday. I spend the day in rememberence of him. He was an awesome friend and companion for more than 25 years. It's been 2 years and 5 months since he went to heaven. I miss him more every day.

Date: Nov 14, 2009

Test socket awesome! Happy Thanksgiving! Current mood:  blessed Yesterday I went to my prosthetist to try my new test socket. It was clear and we had a nearly perfect fit. It felt awesome - like a well fitted glove on a hand. I walked very well with it and it was fairly comfortable putting all my weight on it. I say fairly because there is one small area that needs adjustment as they make the final socket. It is right at the end of my femur about 1" from the very end of the stump on the outside of my leg. My skin and muscle is thin there so they will blow out the side of the new socket slightly in that area to relive pressure and all will be well. My final socket will be ready on December 10th and I now have an appointment with my rehab Dr. on December 14th. He may order some additional therapy but most likely will find me at MMI and make a disability rating so we can proceed towards a settlement. Time will tell. Hope everyone has a very Happy Thanksgiving!

Date: Dec 7, 2009

Way too cold! Current mood:  annoyed As I write this, it is about 5 degrees out and very windy. Average wind chill is 5 below and it it supposed to get much worse tonight. We have a few inches of snow on the ground and I can clear my ramp and a path to the road from my wheelchair in normal weather but this is just too cold!! So, I canceled my ride to the hospital tomorrow for my PT/INR. It can wait until early next week. Looking at the weather forecast it's just too hard to try and shop on my scooter. It's a fair weather vehicle for sure. So I will have to order food delivered from King Soopers on Friday. The charge $10 but it's worth it. I probably have a workers compensation check in my mail today but it's much too cold to even think about a trip to the mailbox. Weather Thursday and Friday is supposed to be much better. Thank God!

Date: Dec 9, 2009

Date: Dec 13, 2009

Date: Dec 18, 2009

Date: Jan 5, 2010

Date: Jan 11, 2010

Date: Jan 13, 2010

IMPAIRMENT RATING REPORT Current mood:  hopeful I received the long awaited physician's report concerning my final impairment on Saturday, January 23rd. It was a copy forwarded to me by my attorney and is published here for the purposes of education and continuing advice on my leg loss due to an accident occurred on June 21, 2007. I do knot know where we go from here as I have not talked with my attorney since receiving the report. It's possible that we could challenge it and request another IME or I suppose opposing consul has the same right. We'll see what happens. FINAL DIAGNOSIS 1. Status post left above knee amputation with functional stump, status post redo left iliofemoral endartectomy patch angioplasty and redo left profundoplasty and patch angioplasty with left external iliac artery stent placement performed February 10, 2009. 2. Probably stump neuroma, currently asymptomatic. 3. "Phantom" pain vs early reflex sympathetic  dystrophy with excellent response to stellate block, currently asymptomatic. 4. Bilateral carpal tunnel syndrome, stable. 5. Peripheral vascular disease, nonindustrial. 6. Type II diabetes, nonindustrial. IMPAIRMENT The impairment for the above body parts was calculated and combined referring to the Guides To The Evaluation of Permanent Impairment, Third Edition (revised). Attention was given to range of motion testing performed in my office on December 17, 2009. With regard to the bilateral wrists, the claimant has a full range of motion. There are no neurological or vascular abnormalities. Based upon lack of loss in range of motion, motor power and sensation the claimant has 0% impairment of upper extremity, which equates to 0% impairment of the whole person as it pertains to both wrists. With regard to the left lower limb, using table 47, page 73, the claimant's condition falls under "amputation above knee joint with functional stump" and equates to a 90% impairment of lower extremity, which equates to 36% impairment of whole person. In addition to the above knee amputation, the claimant has one grade weakness of hip flexion. Using table 48 and 51, the motion involved is hip flexion with nerve involved being the femoral. Maximum loss of nerve due to loss of strength of femoral nerve is 30%. Using table 11, gradation of loss of strength is 1-25%. Therefore, impairment of the lower extremity is calculate at 8% Using the combined values chart, the claimant has a whole person impairment of 41%. The claimant has experienced numbness and stump pain for which he has required and benefited from sympathetic blocks and local injections to the point where the condition is presently asymptomatic and stable. As a result, no permanent impairment is felt to be required. Nevertheless, maintenance care should be considered and is outlined below. PROGNOSIS The claimant is released to a subsedentary level. (The claimant cannot find a clear definition of "subsedentary" anywhere. This recommendation is based upon the results of his participation in physical therapy, his medical condition, and his direct examination and observation during treatment with myself. The recommendation would be that he be considered weightbearing for no more than 15 minutes at any one time or a total of 2 hours in an eight hour workday. He is precluded from climbing, squatting, kneeling, running and jumping. He is precluded from work at heights. He is precluded from stair climbing. He is precluded from lifting over 10 pounds on an occasional basis and 5 pounds on a frequent basis. Bending is limited to occasional. With regard to his bilateral wrists, the claimant is precluded from repetitive and sustained gripping and grasping and from repetitive or prolonged fine manipulation activities. MAINTAINENCE CARE For his bilateral wrists the claimant should retain access to repeat cortisone injections, brace placement once per year, oral anti-inflammatory medications and bilateral carpal tunnel release. For the left lower limb the claimant should retain access to follow-up with his prosthetist for modification of his prosthesis. He will likely require revision of his prosthesis every two years. He should retain access to repeat lumbar sympathetic, as well as local neuroma blocks, neuropathic medication and follow up with his vascular surgeon.

Date: Jan 29, 2010

Things move slowly Current mood:  impatient I finally had a chat with the paralegal handling my case at "The Firm". Looks like things are now in the hands of the insurance company and their attorney's. They have the first right to accept the impairment rating and file a "Final Admission of Liability or challenge it by requesting another Independent Medical Examination. My attorneys will then chart a coarse with which to proceed. Challenges can draw out the whole process by another 2 to 3 months. So, I am impatient and bored. Just have to hang in there and be patient. It's been 30 months now! We talked about errors in the report but never did get around to "subsedentary.

Date: Feb 15, 2010

My mailbox is empty Current mood:  aggravated Category: Life ......and so is my attorney's. The 19th has come and gone. There are rules and laws but they are not followed and big business gets away with it. In conversation today with the paralegal at The Firm who handles my case, I am informed that the attorney has communicated with opposing consul and everyone is just waiting for the insurance company to do what they are bound by law to do. They are past the deadline, so their right to challenge is pretty much gone, or we can certainly fight a challenge that is not lawful, but there is little else we can do but to just wait until they provide us with the Final Admission of Liability. This is pretty much the worst part..

Date: Mar 2, 2010

Date: Mar 13, 2010

It'll be a fight to the finish with stupid AIG insurance Current mood:  complacent ......Well, in the mail yesterday I got a "Notice of Failed IME Negotiation" from opposing counsel. They didn't agree with two good choices that my attorney submitted so that will delay things awhile. They have balked at everything proposed by our side all along the way and they have lost every round. Stupid. On another front, the disagreement with Angela is pretty much history. It takes two to have a disagreement and two to solve. Water way under the bridge now. It was good for Nikko also. I was able to get him the long awaited laptop computer that he had been promised for him birthday. If I die tomorrow, or today, I'll feel good that I've made peace and fulfilled my promise. Praise God. This past week also saw ultrasound studies on my leg and 1/2 and a visit with my vascular surgeon to discuss the results. My right side is just fine. The graft holding well and blood flow is super. The left side is a little different. The artery he has worked on so hard previously is showing sings of closing some. It's nothing eminent that has to be dealt with immediately. He scheduled me for another followup in 6 months but also cautioned me that "I know what to look for" if it closes and creates a problem. I will know it and I know who to call. Yesterday saw me at the eye Dr. for a new exam and new glasses. I'll have to wait 2 weeks for the ordered prescription glasses come in. It will be great to see better. It's been 4 years since my last exam and my eyes have changed quite a bit.

Date: Mar 28, 2010

Date: Apr 3, 2010

Appealing the disfigurement award

Current mood: content

Well, in conference with "The Firm" yesterday, we have decided to appeal the disfigurement award. It was only half of what the law allows for my category. They looked at other awards and are confident we will prevail enough to make it worthwhile.

Date: Apr 5, 2010

Waiting for the DIME Current mood:  complacent I am fine, nothing exciting that is not on my blog - now just waiting to get an appointment with a Division Independent Medical Examiner so see if we go forward to settle or back for more treatment. My hands are getting much worse with my carpel tunnel syndrome but I am still functional. Just had a new evaporative cooler installed so the summer will be more tolerable.

A promised update I promised a few that there would be an update by the end of this week so here it is. But first, I need to take time to wish everyone a blessed and safe Memorial Day Weekend. As I think about all that need to be honored this day, my attention is focused on Arlington National Cemetery.  It is of course a huge place and many famous people are buried there. To me, the most famous is my stepfather and Mom who are also buried there among great people because they were great people and of course my stepfather, Sid was a veteran of 3 wars. Medically, there is really nothing new with me. My rehab Dr. found me at Maximum Medical Improvement on December 17th last year and effectively discharged me from further treatment. He was also my authorized treating physician. My attorney is challenging the whole person impairment rating and we are waiting now for the State to furnish 3 names. We will be allowed to strike one, the other side to strike a name and then we need to make an appointment with the one that's left. That Dr. will decide what to do next - back for more treatment or he will rate me again and all will be bound by his decision. This process is taking far too long as far as I'm concerned but I have no choice but to be patient. At least now the weather has warmed and it's good scooter weather so I can get out and about to, enjoy the sun and people I know that are close by. Some of older friend that go back to when I owned the bar who are awesome friends but I simply don't see them much at all anymore. Transportation is what keeps us apart. Nikko and his Mom keep my spirits up. I also have lots of interests at home to keep me from being board. I'm still very much into Flight Simulator and the whole world to explore still. I talk with friends that I've known for 30 years or more so it's always nice to reminisce. While I'm anxious to get my case done, I know I cannot change the pace or the outcome so I wait patiently. Other than that, Life is good! Remember always, God loves you and do  I!

Good news! Current mood:  happy I have heard from my attorney and the DIME selection process has been completed. I now have an appointment with the DIME on July 19th in Denver. One huge step closer now. This past Monday I went to see my family physician. My blood sugar has been running high and I needed 6 prescription refills. He scheduled me for lab work also i had not seem him since before I was rated at 35% whole person impairment and released to sub-sedentary level of activity. My family doctor laughed and ask if the rating doctor was nuts. Family doctor asked if maybe the rating doctor forgot to put a "1" in front of the 35! We both had a good laugh and certainly did not agree with the rating either. He's comfortable with the challenge we a requesting. I have an appointment with the hospital wellness center to look into my high blood sugar. Guess that's all I know right now.

Well, I've been to the DIME Current mood:  blank but it wasn't pretty!  I had several friends offer to take to Denver and the DIME but I declined all of them. It's about 80 miles north of here or roughly an hour and 30 minutes door to door.  Instead I opted for my attorney to make the arrangements so I would be certain to be there on time and not inconvenience my friends. That turned out to be a big mistake. I was supposed to be in the DIME's office at 10:30 AM for an 11:00 AM appointment. It was 10:00 before I got picked up and we arrived at the DIME's office about 11:35 AM.  My attorney was in the loop because I called at 9:35 when no one was at my door and so a message that I'd be late was already phoned to the Dr.'s office. When I got there, his nurse said he was "cranky" and in a bad mood due to my lateness. Not good. Once in his office, I humbled myself as best I could in apologizing for being late. He said it would now be the short version, due to the lateness. My attorney had requested that the session be recorded, but the DIME engaged me in discussion as to whether I wanted it recorded. My answer was simple, if my attorney requested it, then it needs to be recorded. I was only with the DIME for a half hour. We discussed how the accident happened and the subsequent loss of the leg. He asked me why the lag was taken and the only answer I could provide was that two different vascular surgeon's had looked at the tests on my leg and determined that it had to come off. I was in great and severe pain. He asked me to remove my prosthesis and he examined the stump. There was a discussion about the end of my femur and the pain it caused, also with the skin mass at the end of the stump as it rolls and produces pain. I stated that I was on my third socket without good relief. Next, there was discussion of my bilateral carpal tunnel syndrome and he did tests wirth his mallets and hands. I old him it hurts whenever I do almost anything repetitive or constant for a short period of time. That pretty much was it. He never asked to observe or measure range of motion of my stump. Nor did he measure my hand strength with a meter or instrument as my hand surgeon had done to know for certain what the strength was. So now we wait. Hew has twenty calendar days to issue his finding according the the rules of procedure and there is no penalty if he is late. In general, the rules of procedure are specific but not followed precisely and nothing happens if they are not. Well, time will tell.

 

Friday, July 23, 2010 

Addendum to the DIME visit Current mood:  uncomfortable In thinking more about the DIME appointment and visit something else has come to mind. There was a little discussion that I raised about the prosthesis I have and the knee. I mentioned that at one point rehab wanted me to have a better knee. I was unable to tell the DIME why it nev er came because I do not know who made the decision to stop my rehab, that if I continued I might have it now. He simply asked if I have Medicare and knowing that I was 66, he added that of course I have it. I do hope that he was not suggesting that Medicare pay the $40,000 or so for the upgraded knee that I was initially being considered for. I simply do not think that is proper. The insurance company should be paying whatever it costs to get me back to as normal a life as I can have. It is most certainly not with the knee I have now. Perhaps I shall take a close-up picture and add it to the photos on MySpace. As I look back on all of this, there are two things I am certain of. One, if I had not had the accident I would still have my leg. Two, the Velcro boot that the podiatrist gave me to wear did much more damage to my leg and foot than the accident may have done.

 

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Date: August 1, 2010

Surprise!

Current mood: mostly pissed at the check

Today is Sunday, so this past Thursday I received my bi-weekly check from the insurance company and it's $54.00 short!!! It's been the same amount since they started paying me in December of 2007 (6 months after the accident). There was no notice or correspondence received to explain the shortage.

So, Friday morning I faxed the check stub to The Firm with notations of changes and now await some sort of reply. Too bad they can't just call the adjuster (neither can I). Everything has to go throuh opposing consul who could care less.

Good news is that the last day of the 20 days for the DIME to issue a report is one week from today so hoping for some good news this week. Once again, time will tell.

A couple of outings this past week, one to the diabetes nurse and one to the hospital outpatient lab for my scheduled blood draw to check my PT/INR. My prosthesis in these two outings performed quite well with minimal pain. I was happy!

---

Date: Aug 13, 2010

Update 8-13-2010 Current mood:  bummed Well, my workers comp check has been coming on Thursday or Friday since last March. Yesterday or today there is no check. It's been 2 weeks since I received the short check and still no resolution as to why. I haven't even been able to get my paralegal at The Firm to call me. I left a message for her 10 days ago. Today is the 13th. The Dime report was due on the 8th so it surely should be done by now. But no joy there either. I have left another message for my paralegal to call. Sure is very frustrating   Date: Aug 16, 2010 From bad to worse! Current mood: depressed Well, I did get a call from my paralegal and my attorney at The Firm last Friday afternoon. It seems as though the checks have indeed stopped. The liability of the insurance company for weekly checks was tied to a stupid dollar amount that was on the Final Admission of Liability last March, the one we are objecting to that was cause for my DIME appoint on the 19th of last month. The attorney said that they have twice requested a proper accounting from the insurance company to make certain I have been paid all I am due. That is not comforting at all and I do not understand why The Firm was maybe so busy with other cases that perhaps they weren't paying attention to my case. They know the law, the insurance companies and opposing consul - they've dealt with all of them before and so it seems reasonable they could have given me a heads up on this current situation. Without the bi-weekly checks, I cannot pay my obligations. It's bad enough to live on the very edge of poverty for 3 years without having this taken away. Yes, we are still waiting for the DIME report that was due in 20 calendar days by law. As I write this, it is now 8 days late. I do not know what to do or what comes next.             Wednesday, August 18, 2010  Looking back at workers compensation Current mood:  aggravated Category: Jobs, Work, Careers It's been said and I believe it - that a blog is nothing more than the thoughts in your head put out for the world to see if they care to. So, today I am very very angry at my workers compensation insurance company and the company I work for. They have been behind the eight ball since day one. So here's what is true. The workers compensation law with all of the changes and rules of procedure is very difficult to understand. To that extent, I'm happy that I have law firm looking over my case. No one should ever try to navigate the system by themselves. My opinion only! But the laws and rules are available on line for anyone to try and read and try harder to understand. There are some parts that are very clear and as I read them, I know that my employer and insurance company have never been in full compliance with the law. here's my list of transgressions. 1. None of the required information with regards to what to do if you are injured was in place where I worked on the day of my accident (June 21, 2007). The law is very specific as to size lettering, size of poster etc. NONE of this information was correct. The only info was on a catch all type of employee need to know stuff that still said the minimum wage was  $5.15 per hour. The minimum wage in Colorado increased from $5.15/hour to $6.85/hour as of January 1, 2007, six months before my accident. 2. I reported the accident to my employer through our store manager  immediately upon returning to the store from my delivery as required by employee handbook. There was no response. 3. My employer continued to schedule me for my normal work schedule in spite of my injury. 4. Finally two weeks later I simply went in and said I could not do this any more. I was in far too much pain and it wasn't getting any better. The assistant manager called a number and reported my injury, and the fact that I had reported it to the general manager on the date of my injury. When she was done on the phone she gave me a claim number, an adjusters name and his phone number. 5. I still was not sent to a doctor of my employers choice and I was required to continue to work that day as they had no one available to cover my shift. When I was leaving for the day, I asked the assistant what to do. She said that she thought I had to wait for the adjuster to call. Once again, they failed to send me for treatment. 6. It took my attorney 6 months to get the company's insurance company to admit liability for my accident. They never offered any help with regards to treatment and I was left to fend for myself. They did however calculate what I was owed and paid me retroactively to the date of the accident.  The retroactive pay included an interest payment of $34.85 but NO penalty for not paying on time. These checks have stopped coming and my case is not as yet settled.The law says that if I am a resident of certain counties in the state that I must be placed in a managed medical program. This never happened in spite of the clear wording in the law. I could go on but these have been the major differences of what the law clearly says and how little disregard there is for it and big insurance companies and employers can do whatever that want with no checks on them or penalties for non compliance. One more I can add. I was sent to a DIME which is a Division Independent Medical Examination. The law says this examiner must furnish his report within 20 calendar days. My DIME appointment was on July 19th. Twenty days was up on August 8th. Today is August 18th so it's 10 days late and no one cares except me and my attorney.

Looking back at workers compensation Current mood:  aggravated Category: Jobs, Work, Careers It's been said and I believe it - that a blog is nothing more than the thoughts in your head put out for the world to see if they care to. So, today I am very very angry at my workers compensation insurance company and the company I work for. They have been behind the eight ball since day one. So here's what is true. The workers compensation law with all of the changes and rules of procedure is very difficult to understand. To that extent, I'm happy that I have law firm looking over my case. No one should ever try to navigate the system by themselves. My opinion only! But the laws and rules are available on line for anyone to try and read and try harder to understand. There are some parts that are very clear and as I read them, I know that my employer and insurance company have never been in full compliance with the law. here's my list of transgressions. 1. None of the required information with regards to what to do if you are injured was in place where I worked on the day of my accident (June 21, 2007). The law is very specific as to size lettering, size of poster etc. NONE of this information was correct. The only info was on a catch all type of employee need to know stuff that still said the minimum wage was  $5.15 per hour. The minimum wage in Colorado increased from $5.15/hour to $6.85/hour as of January 1, 2007, six months before my accident. 2. I reported the accident to my employer through our store manager  immediately upon returning to the store from my delivery as required by employee handbook. There was no response. 3. My employer continued to schedule me for my normal work schedule in spite of my injury. 4. Finally two weeks later I simply went in and said I could not do this any more. I was in far too much pain and it wasn't getting any better. The assistant manager called a number and reported my injury, and the fact that I had reported it to the general manager on the date of my injury. When she was done on the phone she gave me a claim number, an adjusters name and his phone number. 5. I still was not sent to a doctor of my employers choice and I was required to continue to work that day as they had no one available to cover my shift. When I was leaving for the day, I asked the assistant what to do. She said that she thought I had to wait for the adjuster to call. Once again, they failed to send me for treatment. 6. It took my attorney 6 months to get the company's insurance company to admit liability for my accident. They never offered any help with regards to treatment and I was left to fend for myself. They did however calculate what I was owed and paid me retroactively to the date of the accident.  The retroactive pay included an interest payment of $34.85 but NO penalty for not paying on time. These checks have stopped coming and my case is not as yet settled.The law says that if I am a resident of certain counties in the state that I must be placed in a managed medical program. This never happened in spite of the clear wording in the law. I could go on but these have been the major differences of what the law clearly says and how little disregard there is for it and big insurance companies and employers can do whatever that want with no checks on them or penalties for non compliance. One more I can add. I was sent to a DIME which is a Division Independent Medical Examination. The law says this examiner must furnish his report within 20 calendar days. My DIME appointment was on July 19th. Twenty days was up on August 8th. Today is August 18th so it's 10 days late and no one cares except me and my attorney.

Date: Aug 26, 2010

Date: Aug 28, 2010

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