Post-Surgery Checkup a Success!

Other than the drive down and the drive back, the visit to Dallas resulted in a successful return to normal life (as far as the return to work and return to martial arts is concerned).  I saw the surgeon on Monday at 1 pm, he looked me over, listened to my list of complaints, brushed them off as minor and things that would go away over time and he said I looked great.  That it was time to go back to my life and forget this ever happened. 

So, to celebrate, I did just that.  Well, I didn't forget so much as I suppressed.  That's healthy, right?

Seriously, though, I got my release to go back to martial arts with the limitation of no physical contact to my head or face and no contact to any other part of my body other than light contact with full protection on.  So moderate and full contact is out until I see him again in 6 months.  In 6 months they will do a CT scan to see how the bones in my head are healing together.  He probably will not release me to spar for quite some time, but at least he hasn't said that I will never be able to do it again.  He seems fairly confident that I should enjoy a full recovery.

I also garnered my release to drive and go back to work.  I will be returning to work on Monday, March 1st.  I will be happy to get back.

That's it for now.  Nothing more exciting than a few comments, a signed release, and a joyful return to the land of the living.

6 Week Checkup

It's February 22nd.  We left Dallas for home on January 22nd.  Dallas hasn't changed much.  It still has highways and overpassess that soar into the sky so cars can drive over and under each other, in addition to around and through.

The drive down was miserable.  Melissa is sick with a cold, I am perfect, the weather is dreary, the doldrums set in about 10 minutes into the trip and... wait a minute... I'm not perfect.  You were going to let me get away with that.  You people... sometimes I wonder about you.  I am recovering from SKULL SURGERY!  Well, so much for stream-of-consciousness writing.  It suffices that we are actually glad to be in Dallas.  We will try to drive back with me medicated.  Maybe that will help.

Once here, we went on a search (because Dallas is BIGGER than Kansas City) for another wedge for sleeping on.  Melissa likes mine so much because it helps her sleep better, that now she wants one, too.  We actually pre-paid for one in KC, but no go.  Shipment got mis-delivered or some such nonsense.  We tried to get one in Tulsa on the way through, but it was Sunday and the store was closed.  We finally found a "Relax the Back" store in Dallas, open till 5 pm on Sunday, and arrived at 2:30 pm.  They were out.  But... they gave us a clue about a mysterious store that existed somewhere to the North of our present location.  A store called... "BackRite".  After much research and digging through ancient texts (looking it up on my Blackberry and calling) we discovered the coordinates of this bizarre bazaar and made our way there, encountering many adventures along the way.  Having been assured this was a business that accepted commerce every day of the week, we were shocked and aghast to find the store... shuttered and barred against the darkening day (it turns out they were closed on Sundays).  Once again, our mission was blunted, our target ever eluding us.  The Incredible Back Wedge remained a possession still wanted, not owned.  We will gather our resources and one day we will try again.  But as it stood, that moment, our reserves were empty.  We made our way back to our campsite and dug in for the night (we checked into the hotel and went out to eat).

Today we plan to go see the surgeon for my 6 week checkup, one month from the last time I have seen my doctor.  He will look at me, exclaim how good I look (even though I now have permanent bags under my eyes), and release me to go back to work with whatever limitations I might have.  I created a fairly detailed release form for martial arts.  He'll need to fill that out as well so I can actually participate.  Right now all I can do is walk around and (verbally) help students with their technique.

As for me, my scar is healing, my forehead lines are coming back, my right eyebrow still will not raise, but I can scowl.  Who needs to look surprised when a scowl will do?  From my mouth, down to my toes, I feel great.  Everything above my nose, however, feels tight.  You know how your skin feels tight, sensitive, and numb all at the same time when you have a bad sunburn on your head?  That's how it feels.  There are still large areas that are numb.  I get some striking shooting pains in those areas, but only occasionally and they do not last.  My scar burns, off and on.  Again, only occasionally.  And I still think about my skull being in pieces, constantly.  I am hyperaware fo where things are in relation to my head so it doesn't get inadvertently bumped.  And speakig of bumps, I also think the surgeons built the bump back in to my forehead.  The swelling is down, and if you look, you can DEFINITELY still see the bump that was there before.  I'll ask the doc about that.

We have seen three movies on our trip (via my PC and its DVD player) that were all good.  White Noise 2, The Invention of Lying, and Law Abiding Citizen.  We also watched several episodes of Legends of the Seeker on Netflix Instant Watch.  While INCREDIBLY campy, it is fun to watch because it was based on a very good series of books by Terry Goodkind called "The Sword of Truth" Series. 

So, that's it for us.  What are YOU people doing?

Filler

I've nothing new to report.  I am slowly getting better.  The numb areas in my forehaed persist and my swelling has returned as I stubbornly refuse to stay in an elevated position while I sleep.  My left eye is still swollen and discolored enough to keep the eyelid from opening fully. 

My scar is burning in fewer areas than it was.  The lumpy areas left by improperly matched edges of the incision are gettting smaller and the evenign pain is MUCH less than it was.  Which is good as I am using no pain killers.  In fact, I am back to taking no exra medications at all.

I am using my icepacks more extensively again, though.

I stopped by to see my peers at my martial arts school.  They are doing well.  Master Instructor Locke has asked that I join him in helping around the school as I am able.  I have agreed so at the very least I can dress out in my uniform and feel like I am participating.  I may be unable to kick and punch, but I can still do most of my forms and show others how to do them as well.  That will be fun.

I have been up and about, cleaned house, been out ang gone shopping, and even done some cooking.  It looks as if I will live.

Not the Oxycodone

Okay.  So last time I was on here, I was having breathing problems.  I quit the oxycodone and the problems persisted.  Yesterday, they concerned me so much, I got a neighbor to drive me to my doctor's office.  They put a pulse/ox machine on me and I registered 99% with a pulse of 72.  All normal.  I was still feeling like I had a weight on my chest, though, so my doctor ordered a chest x-ray and CT of chest to rule out pulmonary embolism.

Great.  Another CT Scan.  This was the 4th CT Scan since December 17th.  It was the 11th time I was dosed with some kind of radiation between the MRI's,CT scans and x-rays.  I think I am done for awhile.

The nurse came out last night and told us the radiologist found no pulmonary embolism and that we could leave.  I went home, fell asleep for 4 hours and woke up without that sense of pressure.  I slept an additional 6 hours last night and woke up this morning feeling fine.

So now I am a hypochondriac.  Ok, then.  Where did I leave those Valium?

Oxycodone Reached Its End

Unfortunately the oxycodone is nearing the end of its usefulness.  I thought this was a symptom of something else, but I have been paying close attention and now I am certain.  Approximately 30 minutes after I take the medication, the oxycodone starts to take effect.  I start feeling better, lighter, a bit nauseous.  The nausea quickly goes away only to be replaced by a heaviness in my chest, a sense of mild claustrophobia or anxiety.  My breathing becomes shallow and I find myself purposefully taking deeper lungfuls of air to compensate.  It's a bit scary, actually

I am now sure that this is caused by my meds.  So, I am off oxycodone.  Instead of that I took NORCO tonight, which is hydrocodone and Tylenol.  I am giving this another try as I never really got the feel for whether it was helpful or not.

Tomorrow I call my pain management doctor and let him know.

New Blog In Town

Okay.  I admit it.  I like blogging.  I just need another outlet.  I have created a new blog.  Come over and see what you think of it.  It is designed more for participation than this one is.  It is called "Cooking with Stainless Steel" and I will record my cooking exploits using a brand new set of Stainless Steel cookware I received from my mother for my birthday. 

It is at http://www.steelcook.blogspot.com/.  You can share recipes, criticize my technique, compare results, ask questions, teach me stuff... or we can learn together.  I am a beginner with stainless steel.  It should be fun.  Stop on by.

Insurance Coverage - Post 1

I know this is the aspect of the whole thing that has interested me the most, mainly because I am the one paying for it (or the balance of it).  And in this year's national discussion on healthcare reform, I thought it would be interesting to find out what happens when a major surgery is required and some of the treatment is in-network (the hospital stuff), some of it is out-of-network (the neurosurgeon), and some of it is in a network that MY network accepts but pays as if it IS out of network (the cranio-facial surgeon).

I will explain that last sentence in more detail as we go.  The actual documentation on this is in a .pdf file that I have linked to the side of my blog.  Look at the top left-hand column of my blog and you can get access to a spreadsheet I created to keep track of this data.

I have not received all the claims yet for this procedure and the hospital bills are not in yet, but there are enough claims in to get a pattern of payment. 

The very first thing that strikes me are the MRI's and CT Scans.  To put this into context, an MRI consists of placing a patient in a machine that may or may not already be paid for.  But it does consume vast amounts of energy that have to be paid for.  The space it takes up in a hospital must be leased out and it must be maintained.  Finally, the tech who works the machine has to be paid and the chemicals they use for contrast have to be paid for, as well as the associated paraphernalia they use to get the contrast into you (needles, gauze pads, alcohol wipes, etc.).  Finally there are the deskworkers who create disc copies of these scans at the radiology front desk for other departments.  Did I forget to mention the film machine that spits out the actual radiological films?  That cost some money for supplies, location, rent, etc.

Now that we have all the associated costs in mind, let's figure out how many they can run a day.  It took about 60 minutes for them to do my MRI.  So, allowing for changing patients clothes, checking patients in, cleaning room between patients, any emergencies that may occur, let's say 90 minutes per patient.  (I may be way off here.  They may schedule them 60 minutes apart and that's why we wait so long).  But at 90 minutes apart, they can start at 7 am and finish at 7 pm, running their techs in revolving 3 day 12-hour shifts.  12 hours divided by 1.5 hours per MRI and you get 8 MRI's per day from one machine.  So how much money do the hospitals make from one MRI?  Well, that's the kicker.  The charged price is all over the place.  It varies WIDELY.

I had 3 MRI's for this surgery.  An initial one at Research Belton Hospital (HCA Midwest-affiliated) that did not get the entire skull and so another was ordered by my neurosurgeon in Dallas.  Then a special MRI that mapped the skull for a GPS-type of device in surgery that helped make sure all the original features were replaced after they removed all that skull.

The MRI at Belton Research was billed out at $6453.00.  They contracted with my insurance company for a payment of $1489.04.  This means at some point, a representative of the hospital and a representative of hte insurance company sat down at a table and dithered over acceptable payouts until an agreement was reached.  This agreement forces the hospital to write off the balance of the charge.  This means that Research Belton wrote off $4963.96 (that is 75% of the billed charge) that they will use as a loss when they file their taxes at the end of the year.  Of that $1489.04, the insurance company covered 100%.  I evidently have pretty good MRI and CT scan coverage.

The next scan I had done was a CT Scan.  CT Scans are almost exactly the same as MRI's.  Big machine, table, insert patient, inject contrast material, take pictures.  Only it is MUCH faster.  A CT scan takes about 15-20 minutes per patient.  So at even 30 minutes per patient it is 3X faster at generating money than an MRI.  That equates to about 24 procedures daily, using the 12 hour day.

I had my first CT scan at St. Joseph Medical Center.  They billed out $1449.85 and were contracted to receive $551.00.  This is about a third of the billed rate.  2/3rds gets written off for $898.85.

It looks like St. Joseph is more in line with what the insurance companies pay, but still, they are overbilling the insurance company 67%.  And if the insurance company did not have a balance-bill clause, the hospital could charge the balance of that money to the patient.  Since they are in-network and there are clauses like that in place, no one has to pay that balance. 

There is a theory out there that says hospitals bill high because they have different payouts from different insurances.  This is true.  Contracts vary widely from insurance carrier to insurance carrier.  Medicare pays out MUCH less than Aetna does.  BC/BS may pay out more.  Humana may pay out even more yet.  If the hospital billed out less than it was entitled to per the contract, they would be leaving money on the table.  Thus, they charge more than the highest payout they get based on the contracts they have negotiated.  That's the theory, anyway.

What do you think?

End of First Week Home

Melissa and I have been home for a week now.  During that time I have cleaned our bedroom, reorganized the hallway closet, finished unpacking our trip paraphernalia (not putting it away, mind you... just unpacked it.  Most of it now sits in a basket waiting to be put away), and been of occasional use to the guys at work  (I had to check in and make myself useful so they wouldn't forget about me).

I have reduced my pain management issues to something that can easily be controlled at the drop of a pill.  My body feels good from my lower jaw to my toes.  I am going to need to start exercising to some extent soon or I am going to lose this litlle pot belly I have been working so hard to maintain.  It might turn into a full blown GUT.  From my upper jaw, UP, however, things are still a bit dicey.

The swelling has gone down considerably on both sides of my head.  My temple areas still have pads of swelling on both sides that increase when I sleep and decrease during the day.  Ice packs still help the burning pain along my incision and the throbbing from the swelling.  But there are fairly wide areas on both sides of my head that are numb.  The borders of these numb areas are surrounded by an edge of tissues that tingles like a foot waking up from sleep.  This leaves the center of my forehead, from the bridge of my nose to my incision line at the crown of my head, feeling normal, except when I put pressure on it.  Then I can feel what I can only assume are bones popping in and out of place.  So I try not to put pressure on it.  EVER!

Here's one thing that may be nothing at all and totally unrelated, but I feel the need to mention it anyway.  I have a dull, bruisy kind of pain when I push on my face just above the flare in my left nostril.  The pain doesn't appear to be IN my left nostril, but behind it somewhere, like back in the sinus.  It almost feels as if I have a sinus infection, but it remains localized and has not gotten better or worse in the last few days.  And I have been on a LOT of antibiotics recently.  I will monitor it and check with my PCP if it becomes an issue.

My jaw is still restricted in how much it can open.  I can put a spoon with soup in there, but I cannot fit a ham sandwich in there without squishing it flat.  When I try to do stretching exercises, it causes some EXTREME uncomfortableness on my left side jaw muscles.  It almost feels like there will be a structural failure back there.  So I try to do only gentle exercises.  How is the dentist going to get in there if I can't restore my big mouth?

My left eye, which had the roof of its home removed and remodeled, does not feel normal.  While there is still some swelling there and I can assume this accounts for some of it, the eyelid still does not open all the way, giving that side a "droopy" appearance.  The lower lid always feels as if there is some kind of grit stuck in there on the outer edge, under the eyeball.  When I wake up in the morning, it is fairly uncomfortable and a film has built up over the eye so I cannot see anything but blur.  After I rinse it out with Visine Tears, the blurriness goes away and the ache disappears, but I can't help but wonder if it is not drying out at night.  I may have to go see an eye doctor to monitor this issue.

I think that is my major list of complaints to date.  Overall, not too shabby for the surgery I had.  I still have to send my surgeons a Thank You card for preserving my eyesight, my innate good looks, my sense of smell and for giving me a scar that I can show off (seriously, though, even THAT is going away).

My next few posts are going to concern themselves with insurance cost and coverage.  Not all of the claims are in, so it is a work very much still in progress.

Pain Management Update

I went to see my PCP on Wednesday, Jan 27th.  She gave me a cursory exam, noted my post-surgical condition and forwarded me on to a pain management specialist.  I go the appointment for the next day.

I received a call from the PMS office Thursday morning confirming the appointment and asked me to download an 8 page questionnaire regarding my pain management history for my current pain issue.  It was VERY detailed and I ended up using about 10 pages (some pages required I print out more than one and I kept adding drugs I had been given in the hospital to little or no effect).

I saw the doctor at about 2:00 and he and I discussed the surgery, discharge meds, type of pain I was having, etc.  After the discussion was over, he noted that he was not impressed with the hospital's pain management process.  He prescribed 2 drugs for me to take.

Because I am having muscle tissue aches, bone aches, swelling and pressure pain, he prescribed oxycodone as an alternative to the medications I had been given that DIDN'T work. 

Because I am having burning pain along my incision and stabbing and shooting pains in my forehead and temple, as well as numbness, tingling and bizarre pins and needles, he prescribed Neurontin as well.

I have used the oxycodone (I got home and took 2 at about 4:30).  I discovered that 2 is about 1 too many and I got really dizzy.  But the pain went away.  I ate a sandwich and the nausea resolved itself and the dizziness died down a bit.  And the pain went away.  I lay down for a bit and, much to my surprise, the pain went away. 

Into the evening my pain stayed away until about 10:45 p.m.  I took another one at 11 p.m. and was able to fall asleep unaided by anything else.  I got 7 hours of sleep interrupted by my cats (to feed them) once during the night, when I took another pain pill, and I awoke with very little headache, though I still had my normal amount of swelling.  I am now in the middle of my day and I have not had another pain pill since about 4 this morning.  To summarize, I would call this a pain management success.

I have not started my Neurontin yet.  The drug makes me nervous because it is a long-term drug.  You don't take it as needed.  You have to titrate up to a certain level, then titrate back down when you want off it.  I'm not sure my burning, stabbing, shooting pains are bad enough to warrant such a long-term drug.  We'll see.

Does anyone else have any experience with Neurontin?  Let me know.

Again, I'm glad I went to go see a doctor.  Just knowing I HAVE pain meds that work make me feel a bunch better.

PCP Visit Today

I have an appointment with my Primary Care Physician this afternoon.  I felt compelled to make it as I do not like the idea that no one in Kansas City is aware of my medical status.  I, at least, want my PCP aware of my post-surgical state should I end up in ER at some point in the future.

I am also going to discuss pain management.  I have not had any pain meds since well before leaving the hospital.  While this got them to stop giving me the wrong stuff, it did not address my pain issues.  And I am worn out.

I get very little sleep at night and what I do get comes in 2-3 hour sections with bouts of being awake.  Being awake in the middle of the night with nothing stronger than Advil on my side is not a great place to be.  I have Valium to take for my anxiety about the pain, but honestly, I can't bring myself to use it regularly.  However, the more tired I get, the less able I am to hold the anxiety at bay, the more I want to use the Valium to control the pain, which it DOESN'T.

I am in need of pain management that provides temporary relief from nightly pain that allow me to sleep undisturbed for longer stretches than I am getting now.  I plan on advocating for just that this afternoon.  I'd have gone in sooner, but this was the soonest they could get me in.

I will post the results of this appointment later.

You CAN Go Home Again.

Melissa and I are safely home.  I love it.  She loves it.  We are home.

I have been giving a lot of thought about this blog.  I put up a new poll to ask how long I should keep it up, but I think I may keep it up for a while, regardless of the response.  I mean, it really does help me as a kind of self-therapy.  I get to share things here that I wouldn't normally vocalize.  (I'm not that much of a seriously emotional guy.  I like to keep things quick-witted and on the surface, mostly.)

Moving forward, I thought I would document my recovery and try to organize this blog into something that might be helpful for others who have to have the same kinds of things happen to them.

I have recently been inspired by another website, a forum, where people actively talk about their experiences.  It is Meningioma Mommas.  The link is http://www.meningiomamommas.org/.  On this site, there are several remarkable people who have survived the removal of various sized and shaped meningiomas.  The reason I was drawn to their site, even though I did not have a meningioma, is that they have all undergone similar open-skull operations to remove their tumors.  As such they have treaded the same waters I am heading into.  The have been a wonderful resource to me in just the short time I have been posting on their site.

I would like my site to become however small a resource to whoever may find themselves in similar situations.  I went through this with my family and friends but with no one who had had any REAL experience with this kind of thing.  There is certainly no reason to do so with so many good resources out there.  I will try to find more and point to them here on my blog.

Anyway, back to documenting my recovery.  I am 16 days post-op and am currently taking no meds other than those I was taking before the surgery, with one exception.

At 16 days, I am still in a great deal of discomfort.  My head actually still hurts, I have a headache on top of that, and my tissues are starting to itch; way down deep inside, they itch.  I understand this will get MUCH worse before it gets better.  My head is also still swollen in the temple areas.  I am bruised in those areas as well.

My pain levels wax and wane with the day.  In the mornings, when I awake, pain is the worst, at about a 7 or 7.5.  Once up, however, I use ice packs, meditation and walking to try to refocus.  By the time I have taken a shower and had coffee, the pain has become manageable, say about a 5 or 6.  As the day goes on, I try to relax, meditate, get soem exercise by walking and pain goes down to about a 3 or 4 by midday.  Then, pain goes back up in the evening.  By bedtime, I am back at about a 6, taking aValium so I can get to sleep again without being anxious that I will wake up in even greater pain.

It's not all bad.  Days are great, nights are bad, but for the most part, I guess I am healing.  My left eye is now about 2/3rds open.  It is still swollen in the lid area, so I expect to get full eyelid motion back.  We'll see.

Other than the head area, I feel great.  I sneeze about 2 times a day for some reason and sneezing is a trip.  Anything that makes my scalp move is a trip.  They cut away all the muscles fromt eh side of my face and re-attached them to the new bone areas.  All that muscle cutting and reattachment makes the muscles pull in bizarrre new directions.  Very trippy.

Hopefully my scar will stick around a bit.  I have a hard time holding on to scars.  They heal to nothingn on me.  Maybe this one is big enough it will stick around.

Well, that's it for today.  I will update in a while to see if anything changes.  Keep thinking good thoughts out there, people.  This, too, shall pass.

On The Way Home

Melissa and I left Dallas this morning and drove halfway home.  We are staying in a hotel in Tulsa before starting off again in the morning.  I could not have handled 8 hours in the car with light-sensitive eyes and squishy stuff in my head.  They don't make enough Valium for that.  But tomorrow, I will be safely ensconced in my own home, recuperating amongst my own belongings, with my cats!!!!  Who love me and want to cuddle with me and lick my incision when I am asleep... 

YUCK!!!!!!  Maybe we can stay here for a few more weeks.

Soon to Go Home

We leave Dallas tomorrow for home.  I haven't seen my cats for weeks.  Worse, Melissa hasn't seen her cats for weeks.  We are very anxious to get back.  For the trip home, I thought we would do it in 2 stages.  Since I will not be able to drive, I figured Melissa could take the trip in two 4-hour segments.   This means we should get home Saturday afternoon rather than Friday late evening.

I'd also like to take a minute to summarize what has happened so far, just so I can see it all in one place.

I was diagnosed with a bony mass in December of 2009.
I was referred to a surgeon in Dallas to take care of it.
December 14th, 2010  We saw the surgical team for initial consult.  We scheduled the surgery.
January 4th, 2010 We arrived in Dallas to get our room, settle in, and get some pre-surgery testing out of the way.
January 5th and 6th, 2010 - Pre-surgery Testing
Thursday, the 7th, I got a rest and spent the day with my wife, my mom, my dad, my dad's wife, and my wife's dad.
Friday, January 8th, I checked in to the hospital and had surgery.  I then entered ICU.
January 8th, 9th and 10th I was in ICU
January 11th, I was moved to 5 South 
January 13th (Wednesday) I was discharged from 5 South on and checked back in via ER on January 14th, (Thursday)
January 14th to January 18th I was in-patient for the second time and discharged on Monday, the 18th.
January 18th, 2010 - Moved from one hotel to another for a better recuperative environment.
January 21st, 2010 (today) - sitting around waiting to go home.

So, from Mid-December 2009 to January 21st, 2010 I found out I had a tumor, researched it, located surgeons and had them remove it and then started my recovery from a successful operation in less than 45 days.  I don't know why that seems fast, it just does. 

My mother talked with a gentleman that was a cashier in a Gift Shop in the Hospital.  She was relating my story to someone in line, and he overheard her and said that he had had the EXACT same surgery.  Only his was done immediately, as he had passed out at work and awoke in recovery.  No waiting around for him.  I'm not sure I know what my point is, except that... he had no contol over his treatment.  I had ALL the control over mine.  I'm not sure which position I'd rather be in.

In either case, the surgery is over, it apparently went very well and now all I have to do is wait for the pain to subside, the bone to grow together, the swelling to go down, my eyelid to raise, and my life to get back to normal.  Here's to normal.

For everyone that has followed this Blog so far, thank you very much for your support, for your comments, for your outporing of care and love.  While it still seems very self-involved of me to have created this blog, I know that I wouldn't have had anywhere near the bright spots in my hospital stay without it.  Thanks for being the beacon that I could focus on during the darkest moments of my recovery.

Before and After Pictures - Revisited

k, here are some new CT scans from AFTER the surgery, in comparison to the BEFORE shots.

Notice the smooth untarnished section of skull

Now here is the AFTER picture:

Everything forward of the staples was removed and replaced

No comments on the number of fillings I have, please.

Here is a frontal view.

And AFTER

There you have it.  As you can see, the skull removal and replacement was throughout a large area of my frontal lobe, into my temporal lobe.  They seem to have put it all back together, though.

Have a wonderful day.

Staples Out and Other Developments

Today I get my staples removed.  It should only sting a little.  Thanks to a card I got while in the hospital, I now understand that is medical lingo for "This will hurt quite a bit, there will be blood, some crying, and possibly one of us may pass out".  I will try to post some pictures of the process.  (My dad wants to be there to see what kind of implement they use and how they are removed.  He also wants to take pictures.)

I am waking up into headaches every day.  The swelling in my face is persistent and seems to develop on the side that I roll my head to when I sleep.  I have tried icing that side of my face during the night, propping my head straight with pillows, using multiple ice packs, but...  still the headaches and still the swelling.  The pain is about a 6 or 6.5 when I awake, but this quickly reduces to a manageable 4 as I wake up and can focus on other things.  I will be asking my docotor today about mitigating factors to this swelling.  Maybe there is something that can be done to reduce it throughout the day, like extra walking, taking water pills, something.

I am also picking up a set of CT scans I had taken during my ER in-patient admission.  I had a copy burned on to a disk for me to pick up because so far, I have ALL my Radiology images.  Can't break up a set now.  When I get them, I will be able to see the extent of bone replacement that they performed and howm many plates and screws went in afterwards.  I will DEFINITELY post some of these images.

Short post for now, but maybe will have more stuff later.  Have a great day!

A Special Thanks!

I forgot to mention that before I was released from the hospital, my martial arts instructor, Aaron Locke, came to visit me in the hospital.  He was in town for a meeting of masters for our form.  After a long day of meetings, he stopped by to see me at about 11 pm.  I was very much still awake and so appreciated his visit I couldn't express to him how much.

He brought me a card, signed by the folks at my school, and I wanted to say Thank You to all of them for thinking of me.  I'll be back, guys.  There seems to be some discrepancy on when, exactly, but they all agree that I will be back.

Master Locke talked to me about the meetings he was in, we talked about other generalities, and then he walked with me around the wing I was in.  It is a small wing, so it feels like a tiny circle if you make more than 5 or 6 laps.  But he walked with me and let me talk about what it was like being there, some of the things I had gone through, and did a wonderful job of listening patiently.  He doesn't think he handles things like this well, but he did a wonderful job for a student and a friend at just the right time.

He stayed with me until I could no longer walk around the floor and other needs were calling.  So I left him to go back to his meeting place and then back to Kansas City.

Master Locke and the staff and fellow students at Locke's Karate:   Kahm sah ham nee dah!

Change in Room Location

There is a certain heaviness or pressure that has to do with convalescing. It affects the patient and almost everyone around them. I feel it as a lack of enthusiasm, a beaten down state after fighting a battle for a war you aren't sure you won.

When Melissa and I moved into our temporary suites in Dallas, we didn't really recognize our surroundings. We were trying to save money, be frugal, and frankly, from the perspective of four healthy eyes and two unwounded people, our rooms were just fine 'cause we were all we needed. However, now that I have been released it is different.

There's that heaviness I mentioned before, add a convalescent who can't lift a hand to help, add a supporting wife who has suffered her own wounds in being there for me, and I saw our surroundings with completely different eyes. The stovetop didn't work, there was a funky smell, the room was all one piece (in fact, the front door was at the foot of the bed). As Melissa moved around the little crappy suite and as I watched her make due with just one more minor insufficiency, I lost my cool, got on the phone, and made reservations at an extended stay facility that is run by the Hilton.

I will grant you the room is more expensive, but the Suite has a separate bathroom, bedroom, living room, and full kitchen. It smells wonderful. They serve breakfast every morning and dinner every evening. I calculated the expense in food out of the price of the room and we are spending about 11 percent more staying here.

And the internet works at full broadband speeds. They even have staff to help Melissa unload the car and put stuff in our room.

The pall of recuperation has been lifted, the healing has begun, and best of all, I put a smile back on my wife's face... And THAT is priceless.

G'night for now from sleepytown. Everyone be safe and know that you all are in our thoughts.

K
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New "After" Picture

I am healing apace. I am ready to be discharged again and am waiting on the doc to finish the discharge paperwork.
Here is me with a bit of a headache (thus the icepack on top of my head).
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Kurt Again!

Well, that post sucked! I just erased a horrid bunch of nonsense.

So, here are the pros: I think I am ready to be released again.
I am eating solid foods again.
My headache pain is manageable and I am on no pain meds.
I am only due to be in town for another 6 days or so. We leave Friday.
I get my staples out on Wednesday.
I have an excellent support staff: my wife, my mom, my dad, his wife, all my wonderful nurses on 5th floor south tower. (Thanks Jenny, Ginnette, Chi, Wendy, Hilary, LaShanda, and everyone else who took care of me on 5 South.)

The cons:
Melissa is getting sick herself. She may have a difficult time taking care of me.
I have started having horrific nightmares. Every time I close my eyes off I go into the worst terrors I have ever had.
My left eye still will not open. A lot of swelling around my face still.

Other than that evrything is super. I just wanted to post to let you know I was alive.

Thanks for thinking if me. I really do apprecite it.

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It's no wonder

When someone hacks on your skull for 8 hours, it's really not surprising that you develop a migraine. I'm just sayin'.

So 12 hours after Kurt was released, we came back to the ER and it was finally determined he has a migraine. Can't stand any amount of light or sound, nauseous, just wanting to lay very still in a dark quiet room. Yep, that's a migraine. It took me a while to convince the doctors that's probably what was going on.

Then the pain med fiasco started. I'll let Kurt post about that himself. In brief, the various pain meds did not reduce the pain whatsoever and they did make him throw up. OUCH for the cranium that was just operated on!

So he's off all the pain meds now just trying to ride out the migraine til it's run its course. He's also on anti-nausea meds every 4 hours. Hopefully he will be back on solid foods soon so he can get out of here. The new countdown is Days Until We Come Home: 7.

Thanks to everyone for such an amazing outpouring of generosity. Sometimes a person might feel like others don't really come thru like they should. In this case, I have seen so much support and generosity and I am ever so grateful for the meals, the full gas tank, the support, having other people here so I don't have to spend 24-7 at Kurt's bedside, and just having other folks I can talk to. It has helped me so much by feeling that others are in this with me. I could not have made it thru all of this in a strange city in a yucky cheap motel room if I had to be here alone. So thank you to everyone for your prayers and support. I am so grateful.

Now if Kurt will just get over this bump in the road, we can get home to our kitties who I miss so very much but are being well taken care of. Thanks everyone!
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Discharged!

Things have been up, things have been down, I'm outta there!

Medically I appear to be fit. My complaints of pain have been relegated to "my head". As if we didn't know.

The pain that I am experiencing has all been of the headache variety. I am not having much skin pain, incision pain, etc. And the pain during the days, for the most part, has been manageable. I got up and walked, improved motility and swelling is coming down as expected.

So everyone expected me to be released today. Last night was a bit different. We aggressively attacked some plumbing issues I was having during the day yesterday and I paid out the results last night. Like a slot machine I kept paying out the jackpot over and over again. I missed dinner last night because of it.

I cramped fairly badly so took my pain meds and other associated meds as well.

Here is a sidenote on pain meds: I was on injection Fentanyl, darvocet or percocet. I could have the injection every two hours but was discouraged from taking it. I could have the pills every 4 to 6 hours but again discouraged. The Fentanyl worked for about an hour but made me itch. I never felt ANY indication that the narcotic pills were working. I finally got my doctors to change my pain meds to Narco. Hydrocodone plus Tylenol. A combination that still produces very little pain management.

So they added Zanex (sp?) and Ambien to the list so I could get some sleep. Because up to that point, I had no slept more than an hour and a half at a time. I took my first zanex and ambien the night I transferred out of ICU. I slept all night but had a HARD time waking up. Felt like a bad hangover. But I eventually got up and around and entertained a room full of people most of the day.
Then came last night. I skipped dinner, ejected all my coins (see above simile for reference), couldn't eat much for breakfast at all and woke up from an Ambien,Zanex,Narco-induced stupor hazy as heck, lethargic and hungover with sensitivity to light and sound and I have not been able to shake it off all day. I have slept more today to escape the nausea-clouded pain than I have since being put in the hospital. And they released me today.

So, to summarize, I think I may have made quite a few poor decisions in my care. I should have demanded better pain management, never taken so much stuff to loosen your plumbing, never taken an Ambien, or Zanex, or the combination... And maybe I should not let them have discharged me today. I do not feel right.

I am in no way hungry, force myself to gorge down the lightest of foods, sit as still as I possibly can and try not to move thid ice pack on my head. I got up to take a walk a while ago and have never felt more brittle. My head is squishy, the internal pressure behind my eyes and nose feel enormous and I feel like my ability to manage my pain with the tools they gave me at the hospital are not working well.

Hopefully this is just a huge pile of "woe, is me". I hope it is. Tomorrow will bring better things. But for now, it's back to sleep, pray the pain goes away.
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Change In Room Location

I've been moved. I overstayed my welcome and was moved off of ICU to South Tower 5th floor. If you want my room telephone #, comment and I will give it to you. Then, for only $2.99 a minute, you and I can chat... LIVE!

Wait a minute. That paragraph went south really fast. Sorry about that.

ICU certainly had nurse availability down pat. I've been waiting for 2 hours for a nurse so far. Nothing yet.

Have a great day!
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3 Days Post-Op

Good morning. I have been out of surgery for about 60 hours. I have learned a few things.

It hurts more at night.

Injections are better than pills but don't last as long.

Neurosurgeons don't like talking about anxiety. They refer you to the hospitalist.

No matter how much pain your in, what time of day it is, it's always better when your loved ones are around.

I asked my craniofacial guy how many screws and plates they put in and he said the manufacturing company would be sending Christmas Cards for many years to come.

The mass has been sent to pathology but no report yet. I'll try to send an after picture.
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Hello from ICU

It's been 2 days since the surgery and I am still alive.

Hello all and thank you for all your thoughts and prayers.

Kurt
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He's up and about

They got Kurt up and walked around a bit. He told me this when I came back from dinner. So that's very good news! They gave him another dose of pain meds so he's trying to rest now while I hold his hand, but what with all the machines whirring and buzzing and clicking and beeping, how do they expect anyone to get any actual rest????? It will be good when he is released so he have some QUIET to get some real sleep. Don't know yet when that will happen but we are all looking forward to it. Now we just have to figure out how to keep him occupied when he's back at the hotel recovering, as we're in Dallas for 2 more weeks...any suggestions, your comments are welcome. I need to find the nearest Redbox for DVD's - do they have those here?
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Still in ICU

Kurt is still in ICU as expected. He's having a lot more pain than they warned us about and he's on 3 different pain relievers which just barely take the edge off. Barely. But they have gotten him up out of bed twice today and he was sitting in a chair for a while. His eye is swelling shut which they said would happen. Keep sending positive healing thoughts. He is slowwwwllllyyy getting better.
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Kurt doing well!!

He's out of surgery in recovery now and as soon as he's settled in ICU we can visit him. The neuro said he's complaining. But that's probably a good sign, I think. Now for the recovery...
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Still going well

Kurt wanted me to keep updating his blog while he's out, so here's another update for everyone. The neurosurgeon is done with the excision and sent the stupid mass off to the pathologist, and the bone for the reconstruction has been removed and is being sculpted as I write this. The "stealth guidance system" they used for the extraction worked perfectly according to the neuro. About halfway through now. Keep the positive thoughts coming!
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Kurt in surgery

Kurt has been in surgery for a little over 4 hours now and the o.r. Nurse says they are opening the skull and he is doing "great" so keep the prayers coming! A ways to go yet. Melissa
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Before Pictures - Final Post By Kurt Before Surgery

Boo!

Blog-Xperiment Final

I think Lorazepam (Ativan) is another word for sleeping pill.  I was drowsy, fell asleep, thus, no anxiety.  I feel robbed.  Ah well.  I took the last pill about 10 minutes ago and am waiting for it to kick in.

Tomorrow morning at 4:30 am I will awaken and repeat my shower from tonight.  Normally I would not tell you about my shower as, let's be honest, no one needs to know about my showers... but!  This time, I did it with a solution called "Hibiclens" and will be required to do it again in the morning.  Scrub everywhere and my head twice. Twice.  I'm gonna be super-clean! 

Then at 5:45 am I will drive over to the hospital with my family in tow.  My mom is here with my step-dad.  My wife is here.  Her dad is coming in tonight.  (His plane got massively delayed and by the time he got here, his reservation had been cancelled at the place where we are all staying and the office closed)  He is staying close to the airport and will come out tomorrow.  My father is here with his wife.  They RV'ed in from Southern California where they were wintering.  My brother is flying in tomorrow afternoon.  Thanks guys.  I guess it IS nice to have people.

My surgery is scheduled to start at 7:30 am with admissions at 6 am.  I will be in surgery for who-knows-how-long, but people start going home after eight hours, so....

I will show Melissa or somebody how to post using my Blackberry so we can get updates from the hospital.

Everybody have a productive day tomorrow and don't spend too much time looking me up.  I don't want the entire plane to come to a stop just because I am having surgery.  (I secretly do, just don't tell anyone)

Days to surgery - none.  Just one looooooong night.  Sleep safe.

Blog-xperiment #1-B

30 minutes in and I am still awake.  My anxiety does seem to be reduced.  I have been playing on-line pool and my ability to shoot has been reduced but that mya be because I am getting sleepy.  The two may be related, the ativan and the sleepiness. 

My toes tingle.  I think the experiment is over.  Going to take a nap.  This was not as fun an experiment as I was hoping.

Blog-xperiment #1-A

I changed the name of the title.  Now it's more fusion.  Ok, so I am a little less headachy, but hat could be from all the hydration (I am drinking a lot of fluids).  My fingers seem more leaden as typing is becoming a touch more difficult.  Otherwise, still fairly clear-headed.  See you in 15 minutes.

Blog Experiment #1

I have just taken my first lorazepam (aka ativan... I misspelled it earlier).  I will be checking in every 15 minutes to tell you what the effects are like. 

So far, feel anxious and headachy.  No effect yet.

Bravery is Over-Rated

The sun has a tendency to drive away persistent fears. No shadows lurk, no secrets abide, no lingering doubt exists when the bold light of the sun shines down.

When the sun is out it's easy to be brave. But when it goes down... Things get tricky. It's tough to be brave when your guts are twisted, every second is an effort to keep your lunch down, when you have to distract yourself with a million different things to keep from thinking about the darkness that surrounds you.

Not that I'M like that, mind you. I have this thing licked (it is daylight out... Right?) And the only discomfort I have been subjected to is a little lost sleep. The end result is a grumpy Kurt. A poked, prodded, stabbed, irradiated, grumpy Kurt.

So, for my family's benefit, I have decided to forego bravery and call the Doctor's Office for some meds. They have prescribed me two pills of Atavan. It ain' t Valium, but... whatever!

With a little help from my chemical friends I found out you don't NEED bravery; entirely overrated, been done to death, bravery. So, here's to tonight with all the horrors that darkness holds.

Kiss my ass! (Pardon my French)
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Test post from Blacberry

This is a test sending a post from my Blackberry. If it works I won't have to fire up my computer for an entry.
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Second Set of Appointments Over!

Nothing to say today. 

Today was rough.

I will post again before the surgery and maybe put a bright smily face up so we can compare what comes after.

The good news is that EVERYONE at the hospital RAVES about my neurosurgeon.  I mean, like they were members of his fan club.

Until the morrow comes...

1 full day left to enjoy before surgery.  I may need Valium.

First set of appointments over!

It turned out to be a long day today. 

It started out by a visit to the office of the Hotel complex.  I wanted to request a new television for our room.  I know, I know.  They don't DO that kind of thing.  But here's my deal:  they said they would put me in a room with a new TV.  They didn't.  They put us in their worst room, if the others we've seen were any indication.  We got to choose our new room, which was nice, but no new TV.  So I thought I'd ask the Front Desk person.

She said "No".  Quoted policy at me.  I gave her my best retort.  Then the Manager came out and got MAD at me for giving her front desk person a hard time.  I hadn't raised my voice or been anything other than courteous.  I WAS persistent... I will give you that.  Anyway, I got angry at the lack of reciprocal courtesy and... well, I'll be surprised if I have ANY television in my room tomorrow.

After the office visit, Melissa and I trekked over to the hospital for a 1 p.m. appointment with my neurosurgeon.  He re-explained my procedure from his perspective.  He will be performing a bifrontal craniotomy to 1.expose the excision site, 2.provide bone for the craniofacial guy to reconstruct, and 3.to cranialize the frontal sinuses (remove them).  After the surgery I will go to recovery and then to ICU where I will stay for a minimum of three days (per the neurosurgeon).  At some point I will be discharged, returned to my room, where I can only sit on a straight back chair, or lay flat on a bed with my head propped up on a minimum of two pillows.  That will be fun.

At 2:30 p.m. I headed down to Radiology and had an MRI performed.  This is a special MRI that produces data that can be fed into a computer system much like a GPS that maps locations in the geography of the brain.  I am imagining this computer-driven set of arms that comes down from the ceiling of the operatory and, guided by imaging data, starts automatically excising bone tissue based on pre-determined cuts and measurements.  I hope they put my head under it the right way.  (This machine does not really exist, dear readers, except in my imagination... but then again, what do I know?   Maybe it does.)

The procedure started about 3:15 p.m.  Everyone was nice, friendly, and polite.  The MRI tech came in to deliver the contrast and HE gets an F for the day.  His skill with a needle was nothing if not inventive.  Finally, at about 4:30 Melissa and I left and went shopping.

While out at Target, I received a call from the Radiology Department asking if I could come back in for MORE images.  It appears they did not get the right type of filter settings applied for the GPS machine-thingy.  So we drove BACK to the hospital, where I had another hour's worth of images taken.  We finally left about 7:30 p.m. and got back to our room.  I had them make me a copy of the images and put it on disk, but they don't look any better than the others.  Here is an example:

Ok, that's it for me for tonight.  Thank you so much for tuning in. 

The next post will be about insurance claims... I promise!!!! (For those of you who need sleeping pills)

New Poll Out Today

Be sure to stop by my most recent poll, where I ask about Before and After pics.  I haven't decided whether I will be posting any.

Pre-Surgery Testing and THANKS!

Evidently intracranial surgery requires a minor amount of preparation.  I have pre-surgery testing scheduled for Tuesday and Wednesday.  On top of the MRI and CAT scans that were done in Kansas City, and the CAT scan that was done here in Dallas the last time we were here, it appears I need ANOTHER MRI, this one using STEALTH filters that will allow a GPS system to map to it so that more exacting cuts can be made.  Don't ask... that's all I heard... Stealth Filters, GPS System, Exact Cuts.   All the rest would be me making up a bunch of stuff to make it look like I knew what I was talking about.

Anyway, that is being done tomorrow at my neurosurgeon's behest.  I then see the neurosurgeon for a brief tête-à-tête.  He will be asking for my input into best methods for intracranial access, taking my opinions and filing them in File 13 (that would be the trash can, for those of you who have never filed).

On Wednesday, I have a full day starting at 10:30 am with admissions paperwork, blood testing, full physical, etc., then upstairs for a photo session (give me sexy, pouty... now growl, like a lion!... work it, work it....).  After the photo session, another tête-à-tête, this time with my craniofacial guy, and to wrap up the day, a CT angiogram.

I have Thursday off before they strap me to a table Friday morning and send me off to oblivion. 

I want to take a minute to thank everyone for their support and well wishes.  My wife, my parents, Tony and Monty, Ryan, Cheryl, Jason, Mendi, Laura, Nick, Kalin, Cindy, Melanie, Kristin, Tim, Tyler, Darren, Karen, Master Locke, Wayne, Martha, David, Lucinda, Tabitha, Alex, AJ, Amanda,  Aunt Jan, Bob, Leah, Hanna, Ryan, Instructor Locke, Instructor Carrillo, and everyone else I forgot to mention, THANK YOU!

....4 Days to Surgery.

Arrived in Dallas

Melissa and I left for Dallas at 9:08 am this morning.  We arrived at 5:30 p.m.  The trip was uneventful.  We checked into our hotel to find the room wholly inadequate.  It smelled of wet cigarettes, the TV would not connect to my XBOX 360, the filter in the coffee pot was untended since the last tenant (and jusging by the mold in it, that was some time ago).  It looked like the front door had been kicked in and the security bolt replaced.  In other words, unsatisfactory. 

I took the coffee filter up to the front desk and asked if this room was the best they had to offer.  She showed us two other rooms.  Each had it's pros.  The first one smelled great and looked freshly remodeled.  The second one was dank and musty, but had a new tv that would hook up to my XBOX. 

Melissa made me choose the first room. 

I still haven't given up on trying to get one of those other TV's in here, though.

So, now we are moved in to the room where Melissa and I will spend 3 weeks.  We have unpacked our clothes, games, food, snacks, etc. and are settling in.  Here are a few pictures of the place.

Blogging Help

Okay.  I am asking for help.  This Blog is not designed well.  It may be that I do not know how to use it.  I cannot quickly see any comments that people are adding, nor can I see how to readily comment back on someone's comment.  For instsance, if someone comments that I am in their thoughts and prayers and I want to respond, I can't seem to find a good way to do that other than to comment on their comment.  (Well, THAT sentence was a mess).

I guess I am looking for a better way to set this up.  When the year changed, all my previous posts disappeared in the blog archive, hidden under the heading "2009". 

Anyone have any suggestions?

Thanks in advance.

Financial Stuff - The Beginning.

SPOILER ALERT!!!!  The following post may very well be soporific (still trying to get some points, here).  Please do not operate heavy equipment or drive while reading.

Well, the poll is not over, but I think I get the general idea.  Overall, those of you who voted would like to see what all this stuff costs.  So, as an experiment, I am going to try to put together something that summarizes Dates of Service, Procedures, Associated Costs, whether or not it was in-network or out-of network, how much the insurance comapny paid out and then how much was written off as a result of negotiated contracts.

To begin, a real quick primer on insurance claims.  (If anyone has any corrections they would like to make or additions that might make it EASIER to understand, please feel free to comment.) 

All physicians, hospitals, medical providers, etc. have charges associated with their services.  These charges are the same no matter who gets seen or what their insurance coverage.  Person A is uninsured.  Person B is insured, but out-of -network.  Person C is insured, in-network.  The hypothetical patient has an Office Visit.  For this visit, the physician charges $250. 

Side Note:  All charges accrued by the patient are ultimately the responsibility of the patient.  Claims filing is a service offered by the physician and is not a requirement.  The patient must follow up and make sure all claims have been filed and paid out per contract.

Person C owes the co-pay required by insurance (say, $20).  The rest is billed to the insurance company.  The insurance company has a contracted rate with the physician that allows the physician to bill $85.  Of this, $20 has already been paid by you.  The insurance company pays $65 and the physician is REQUIRED to write off the rest.  $250-$85=$115.  That $115 cannot be billed back to the patient. Person C pays $20.

Person B owes all $250.  They may be required to file their own claim to recoup some of that money.  Or the physician's office may be nice and bill for them.  The insurance company will probably pay 80% of the charges after they have applied a "usual and customary" rule to it and reduced the charge.  So, of $250, the insurance company says, "usually the customary charge for this service is $165.  We will pay 80%, or $132."  $250-$132=$118.  Person B owes, not only 20% of $165, but the unpaid balance of the physician's charge.  Overall, person B pays $118 (if his deductible is met; otherwise he pays all $250).

Person A is not covered by insurance at all and owes the full amount.  Person A pays $250.

The reason I covered this is because some of my claims are going to be paid in a special out-of-network category.  My insurance company negotiated a contract with another insurance company (not the physicians, themselves) to pay at THEIR contracted rates.  So, if I go see one of these doctors, my insurance pays out at 80% of THOSE rates.  I owe the 20% but the balance of the charges cannot be billed back to me because of that contract between their insurance company and mine.

Side Note:  If you, my readers, haven't tried this, I highly recommend it.  Repression of feelings through analytical analysis ROCKS!!!!!!  I feel better already.

Happy New Year!

Happy New Year, everyone.

I have written this post 4 times now.
I keep deleting my entry. I guess I am not having a good day today.

Sorry.

I'll try to do better later.



7 Days to Surgery.