Did you think my personal medical saga was on the mend?

Ha ha, fooled you. I’ve been getting steadily worse. My ankle is totally fucked up, my whole foot is swelling like a balloon, and to top it all off, the problems are spreading to my knee. I’ve been reduced to lying immobile hoping some random twitch doesn’t trigger spasms of pain.

Last night was the worst. I’m trying to find a position I can sleep in, rearranging limbs and whimpering pathetically at every twinge, when Mary suggests we go to the ER. “No,” I whined. “I have to man up and deal with this in my manly masculine stupid way. I can’t admit that I can’t deal with this!”

Around 2am I turned to her and said “I can’t deal with this. Take me to the ER, please,” and she did.

So I was shortly stretched out on a table and a nurse was sticking an IV in, and then the Dilaudid flowed. O Sweet Relief! Then another liter or three of blood was extracted to pay for it, and I got lots of blood tests (which came back mostly normal). We’ve got to figure out what was going on, so there were a great many needle sticks as the doctor tried to draw fluids out of my joints, both the ankle and the knee. He succeeded, and slurped about 75mL of Mtn Dew out of me.

If I installed a tap in my knee, I could apparently get free Mtn Dew* at will.

The fluids have all been sent up to a lab in Alexandria. They’re to see if I’ve got an infection, or weird sharp crystals in solution damaging the tissues. He didn’t think it was an infection, and my uric acid results were normal, so he’s just being thorough. It’s time for some thoroughness here.

It’s also time for some pain management. I’m now on NORCON every four hours, for the next 5 days, and prednisone once a day for the same days. I’ve been on this before, and know what to expect: insomnia, diffuse anger at everything, and a wobbly, semi-drunken perspective on the world. So I’ll be ready to blog, in other words.

I’m also aware that I’m getting a few opioid doses here. There have been limits set on their use, and I’ll respect them. These things are scary. I’m just hoping I get an effective treatment before I have to stop taking the potent drugs.

I’m meeting a podiatrist tomorrow, and what will then follow is a solid plan of treatment. For now, it looks mainly like wearing the horrible boot and confinement to my house, where Mary will wait on me hand and foot. Maybe I should order a little silver bell from Amazon? Yeah, no, I don’t want to take her for granted.

*Warm, flat Mtn Dew that mainly tastes of salt. Maybe PepsiCo should think of a new flavor, Mtn Dew Synovial Goo.


  1. Jazzlet says

    Glad you have some effective pain relief, hope you get an effective treatment program tomorrow.

  2. andersk3 says

    I had similar inflammation and pain last year, though it was entirely localized in the ankle joint (it doesn’t sound like yours is?). I had one doctor tell me I needed a fusion. I was 48 and didn’t really want that so I got a second opinion. It was there I learned that an ankle replacement is now a thing and I went for it. Best decision I ever made. Putting it out there as it’s not a well known procedure.

    Wishing you well, I understand the fire your feeling. Sucks.

  3. stwriley says

    Looks like you’re finally getting some proper treatment, so hopefully you won’t be in such pain soon. I was surprised that you didn’t get prednisone before, especially injected into the ankle in the first place to take down the swelling. With any luck, this will do the trick and you’ll get some relief. Take it easy and know that all of us chronic pain sufferers sympathize whole-heartedly.

  4. Thomas Scott says

    Oh man, I remember the 14ga needle they jabbed my knee with. My sadistic NP said that was the price of the disabled parking permit.

  5. Snarki, child of Loki says

    This whole bipedalism thing has got some problems.
    I blame gravity.

  6. says

    dilaudid is pretty fuckin rad. laid out by my first kidney stone experience, they gave me that, and sent me on my merry way. just knowing the kidney stone was still in there, nothing changed except the pain, it boggled my mind.

  7. petesh says

    Sorry to read this, PZ, and hope you feel better soon. Be careful with that Prednisone — it cured me of Giant Cell Arteritis nine years ago, or at least crushed the symptoms, but I have been unable to get off the damn drug. Even my doctor has pretty much given up; my maintenance dose is small enough (2.5 mg) that I can probably take it until I die. At lower doses I go nuts, extreme emotional instability. Take care, get well!

  8. says

    Dilaudid? No thanks. It almost killed me once. I was in the ER with extreme nausea and someone gave me Dilaudid*. I could feel it moving up into my neck as it made me feel worse and worse. The next thing I know, a bunch of ER nurses are around me, trying to get me to respond. My wife said that I blacked-out, my HR crashed down into the 20s, and the monitor alarm started going off. She ran out and got the attention of the staff who then revived me. At the time, I was a competitive distance runner and my resting HR was around 50. Dilaudid pushed me off of a cliff.

    *Pro tip, if someone asks if you’re in pain or have discomfort and you have nausea, DON’T say “yes”- instead, be very specific and say “No pain, just nausea”. One potential side effect of many pain meds is nausea (along with depression of HR). And before I blacked-out, the sensation was anything but pleasurable or relieving. I would’ve begged them to take the stuff out if it was possible. There are some effective anti-nausea meds they can use.

  9. charley says

    Well, that all sounds awful. I hope you are on the road to recovery soon. Your ready to blog comment was good for a laugh.

  10. whheydt says

    Re: jimf @ #9…
    When my wife had pancreatitis she was on a pain killer that made her nauseous (really no fun while she was NPO), but there was also an anti-nausea drug.
    In general… A caring partner/spouse is beyond price. My wife had to do much the same while I was recovering from a broken leg. I returned the favor during her final 8 month decline from ALS. I will always miss her…

  11. llyris says

    Sympathies, it sounds painful and long winded.
    I have to take prednisolone at times and it really is insomnia and diffuse anger. My husband calls it ‘eldritch dark sewing energy’. Blogging sounds like a valid alternative.

  12. wcaryk says

    You say your uric acid levels are normal, thus no gout — but I was once diagnosed with “pseudo gout”, caused by calcium pyrophosphate buildup. You might want to run this past your t̶o̶r̶t̶u̶r̶e̶r̶s̶ doctors.

  13. dlpthomas says

    You can have acute gout with a normal uric acid level – hence sending off the crystals. And just to make life difficult you can have a septic joint and gout simultaneoulsy (or an infection and pseudo gout) – bacteria love abnormal joints. It might take a while to sort out so good luck. (If you were in Australia you’d probably have been admitted and it wouldn’t have cost you anything. Socialised medicine, baby!)

  14. fentex says

    I recently left hopital after three months because of a staph infection that had similar early symptoms, and are now getting about on elbow crutches (which I expect to use for at least another month). From what was initially asore knee I’ve had several surgeries to wash out joint infections and two months of IV anti-biotics to clear out the sodding bacteria (that had colonised my heart with a 3.5cm growth on my tricuspid valve) and my muscles gradually withering away from bed rest.

    Quite surprising how fast your muscles fade. My illness was complicated by sports injuris to one of my knees meaning when the other leg was compromised by surgey I had no good leg to compensate with, and a mysterious incident of anemea that was apprently down to a never precisely identified internal bleed but required multiple tranfusions.

    And I was lucky for having an ancestral strain of staphyococcus aureus still susceptible to pennicillin.

  15. says

    Dilaudid: It was used one time, while fluid samples were taken. I must have had a low dose, because mainly what it did was dial down the pain.
    Prednisone: Plan is to take it for just a few days, to get the swelling down. I’ll wait and see how the plan changes when the doctors talk about surgery. I’m keen to get off it — last time I took it gave me extreme insomnia, and I’m tired enough.
    Hydrocodone: I’m not thrilled with that, either. I take it once every 4 hours, and that means the two hours in the middle are just lost — I’ll be zoned out and dizzy. Not compatible with teaching.
    Results so far say it’s not an infection. If the results from the fluid sample show crystals, I’ve got colchicine to take that down.

  16. nomdeplume says

    @19 If it is gout (the swelling doesn’t really fit) the colchicine needs to be taken immediately the symptoms start. If that is the diagnosis make sure you have colchicine on hand (it lasts well) and take it as soon as possible next time. Wisshing you a quick recovery.

  17. chrislawson says

    PZ, glad you’re getting more acute attention, hope you recover soon.

    Re morphine: dependency risk is low for short courses treating severe acute pain, especially if you reduce your dose as the pain decreases.

    As dlpthomas says, you can have gout with normal uric acid levels. I won’t go into the biochemistry here, but it’s not as uncommon as people think — and it’s also not uncommon for doctors to not understand this, I’ve had to explain to several colleagues in the past why you can’t rule gout in or out based purely on uric acid levels. Plus, as wcaryk says, it could be pseudogout which has nothing to do with uric acid at all and can only be diagnosed by joint aspiration. While nobody likes the idea of sticking a needle into an inflamed joint, if it’s done proficiently it’s not all that painful and it is the definitive diagnostic test for several important causes of joint pain (gout, pseudogout, infection).


    Swelling is one of the classic signs of gout. Not everyone with gout gets noticeable swelling so it might not be your experience, but it’s one of suggestive triad (joint pain, swelling, redness). Of course, the amount of swelling PZ describes is atypical of gout, but then it’s atypical of almost everything other than major acute trauma which we know he didn’t have.

  18. says

    That sounds awful. I much prefer Diet Mountain Dew. Seriously, hope they’re able to treat you and not break the bank in the process. Or steal too much of your precious bodily fluids.

  19. hemidactylus says

    I had to take prednisone orally for a week for what wound up being contact dermatitis and wow, just wow. A coworker had to take it for a chronic condition and I noted how it led to excessive chattiness. When I took it I realized why. The first night was head rushing reminding me of an intense cryptobuzz though not nearly as fun. I had serious trouble sleeping. Tons of energy. I may have been a bit irritable, but cannot recall. It got better through the week. I changed to bar soap and clothes detergent without perfumes and that seems to have eliminated the rash since 2019.

    I’m still on post-op loteprednol (prednisone like) based eye drops, now one per day, after the cataract surgery thing. Thankfully those don’t have any discernible psychological effects. I guess it reduces the risk of retinal swelling or something. That seems bad to have. Eye drops are pretty easy.

  20. Edward Bosnar says

    Long-time reader, only very occasional commenter, but I have to say I’m very sorry that you’re going through this. Best wishes for a speedy recovery.

  21. nomdeplume says

    @21 Yes, I get swelling and redness only around the big toe basal joint (where gout always strikes me), I was commenting on PZ’s generalised foot swelling which is certainly not typical.

  22. wzrd1 says

    Immune system turns traitor vs infection or defect.
    Yeah, regardless, no instant cure, no eventual cure, just, SOL.
    Hopefully, you get an effective treatment soon, real soon.
    Actually, treating that effectively would likely deflect a half dozen other major autoimmune diseases.

  23. wzrd1 says

    For the few confused, the immune system is complex, beyond imagination and well. makes mistakes.
    Rheumatoid arthritis as an example.
    It varies on scope, due to numerous reasons, most still ill researched.
    Don’t get me started on Lupus, which my late wife suffered from.

    PZ is unique, treasured as such, rightfully so, as is all of his family and friends and rightfully so.
    He’s a problem, that is significant and must needs be addressed, save in uncivilized societies.
    Yeah, you get my backswing.

    As for opioids, yeah, no. I instantly flush with histamine response. To near allergic levels.
    They work great, but feeling like death arrives, thanks, but no thanks.

  24. wzrd1 says

    Oh, for the record, I’ve had multiple versions of opiates and opioids.
    Massive MAST cell response each time.
    Controlled pain wonderfully, while doing its level best to actually kill me.
    Close to, but not actual allergic response.
    The feeling of doom, well, I’d rather use an angle grinder against my own asshole and grind up, rather than experience it again for the fifth time.

  25. felixd says

    Wishing you all the best PZ. Been reading and admiring for close to 20 years now. Get well – we all need you.

  26. says

    Dettmer’s book Immune is really good. At the end he explains many ways that “immune boosters” would be horrible if they actually worked.

    Years ago a friend had similar symptoms and it turned out to be parvovirus. It took a senior diagnostician who actually taught diagnostics at Johns Hopkins to figure it out. Unfortunately the current medical system has no niche for expensive walking libraries. Don’t worry, ChatGPT will tell you…

  27. Just an Organic Regular Expression says

    FWIW, I live in a senior residence and among my neighbors, joint replacements are very common. Knee and hip are the most frequent, but my next-door neighbor recently had an ankle replaced, and is pleased with the result. I could put you in touch with her, but you can probably find local people who will give a testimonial. Ask around.

  28. says

    ChatGPT will tell me whatever I want to hear.

    Ivermectin twice daily, with a bleach chaser.

    No seriously, please get well. Thoughts and sprayers.

  29. wzrd1 says

    Marcus Ranum @ 33, didn’t ChatGPT also suggest a rectal UV flashlight to cure everything too?
    Or was that another idiot bot that suggested that?

  30. magistramarla says

    I’m right there with you. In fact, I can probably do you one better, since I’ve had anaphylactic reactions to any opioids.
    Heck, I even react to poppy seeds. I’ve accidentally ingested salad with poppy seed dressing and felt my lips and toungue start to swell. It’s tough having spinal surgery (which I thoroughly regret having) when you have to fear that some well-meaning medical person will kill you by giving you an opioid.
    One pain management doctor in Texas (a woman!) told me, “Well Honey, if you won’t take opioids, then I can’t help you.”
    Feel free to imagine the above being spoken with a course Texas drawl.
    I also have some autoimmune issues, including Sjogren’s Disease. I’ve had to try to convince doctors to actually treat me for the chronic pain caused by this systemic disease. Many of them just consider it a nuisance syndrome that only causes dry eyes and mouth.

  31. magistramarla says

    PZ, I feel for you. I deal with chronic pain every day.
    My advice for you is to start physical therapy as soon as your doctor will allow it.
    Find the very best PT that you can. HINT: I’ve learned to steer clear of those who are affiliated with a hospital or doctors’ group.
    Stick with the PT for as long as possible, and after that, ask your doctor to send you back for “refreshers”.
    I think that my physical therapist is the only medical professional who listens to me and she’s the only reason that I’m still able to walk.
    I wish you luck dealing with the healthcare system.

  32. Daniel Storms says

    Since you’re going to be laid up and on prednisone, see if you can find a channel/stream showing “Bigger Than Life,” a 1956 film by Nicholas Ray. James Mason is a schoolteacher with a near-fatal disease that is treated with cortisone. but he feels so good with the steroid that he starts taking more and more. Soon he is a meglaomanical, paranoid, homicidal monster. Saved eventually by Walter Matthau. Cautionary tale. Prednisone is a problem for me because I’m diabetic, and steroids tend to send my blood sugar into the ozone. I find with opioids (thanks, Sackler family, for making doctors too overcautious with them) that they don’t so much eliminate the pain as not make you give a damn about it.

  33. wzrd1 says

    When initially thought to have COVID, I was spiked with prednisone and had insulin prescribed and administered.
    Yeah, a bit of an issue, but doctors know and address such potential issues.
    I typically run around a 120 – 150 glucose, which rapidly depletes upon any sprint activities. That, observed twice medically.
    When I did have COVID, well, that wasn’t addressed until two weeks later, when I spiked again and was hospitalized due to a loss of consciousness event. But then, I was in a homeless shelter, where life is trivially discarded.

  34. chesapeake says

    I think PZ is fortunate to have access to so much advice about all this. Could really help him.