TMI Nurse Health Educator, “Surgery, Infected Toe, and a Dash of COVID Farce”

March 15, 2022
My CT Scan. It is of my lumbar spine and helping to prove that the surgery on 2/7 was highly successful. The left view is the Sagittal (side) view. The right image is Axial (cross section)

For those readers with no attention span who enjoy spoilers taken completely out of context: I’m going to have another major surgery soon. I have an infected toe. And I was diagnosed with COVID. You can now choose to either stop reading here, and completely misunderstand major parts of the story, or you can enjoy my latest health update. As my favorite childhood book series used to demand: choose your own adventure.

It’s been over two weeks without a health update, did you miss me? Like a TV recap, let me remind you of where we left off…Exceptionally successful L4/L5 disc replacement, but the day after my hospital discharge, I returned to my own Saint John’s for a bladder issue (RESOLVED), but the ER completely ignored the crippling pain in my back as I stood with my walker, or sat to the best of my ability, and was given absolutely no back support for SEVEN LONG HOURS. Over the next few days, a bunch of rest, steroids and tests later, I was diagnosed with a brand-new cervical disc herniation and compression, caused by the ER visit. The pain was mostly gone, but I was left with circulatory problems of numbness and tingling down my arms and legs. That’s where I left off, and even had an article written about it in the Jewish Journal linked here, if you’re interested in more than these few lines of catchup.

Regarding last month’s back surgery, the recovery has continued to be phenomenal. I’m now able to walk for about fifteen minutes without the use of any cane or walker. I’m blown away by how well it went and how much I can move already. Everyone told me how phenomenal my doctor Brian Gantwerker is (half the doctors I’ve spoken with have had family members or their own surgeries done by him, a true vote of confidence), but between how well I’m moving and his bedside manner, he’s really lived up to the hype. Following my precautions, I still am not allowed to BLT – Bend, Lift, Twist – but walking around the house is mostly easy. Admittedly Adi still must do literally everything for me, since I’m not allowed to carry things over 5 pounds, and thanks to the new cervical injury with numbness and tingling, I can’t drive for a while longer. So, it’s time to discuss the new injury…

After my new cervical diagnosis, I continued taking muscle relaxants and anti-inflammatory meds, and I had 2 weeks of home-visits from PT. Unfortunately, it did not improve any of my new circulatory problems, if anything it stimulated them each and every time with no positive effect.

Then last week, something alarming happened. My right foot went cold, but otherwise felt normal, and stayed that way for a few days. I spoke to the surgeon who did the vascular part of my surgery, and thankfully it was not an emergency, since I was able to move the foot and walk on it without any issue. And go figure, he also said it made sense given the cervical injury. But crisis averted. Then that Sunday night I woke up constantly in massive pain in my right pinky toe. I looked at it and the toe was clearly infected with an ingrown nail. What else could go wrong?!

Photo of my ingrown/infected pinky that I sent to doctors before being treated by Michael Levi

Fortunately, I have superb personal doctors, colleagues and friends. Early the next morning I was texting ugly photos of my pinky to Rachel Bak, my dermatologist who’s also been a dear friend since college. At the same time, I was texting with my friend and coworker Romina Vincenti, a podiatrist who isn’t in my insurance plan. Both were helpfully giving their informed recommendations. My podiatrist Michael Levi is so good, that he’s actually the doctor for the LA Clippers, working on the many foot issues that basketball players encounter – an article in the LA Times about his great work is linked here. He was able to fit me in me that morning and was baffled by how someone could get an ingrown nail when they aren’t even wearing shoes for the past month?! But nonetheless, he took care of it, and I’m soaking my toe in warm water and Betadine as I type. Also, the busy doctor has found the time to call me every day this week to see how I’m doing. Great care team!

Over the past few weeks I’ve had a totally normal MRI of my brain, MRI of my thoracic spine, and even a CT of my lumbar spine which shows that the surgery was totally successful and none of my nerve issues that I’m experiencing are from that region (or the surgery). This seals the deal of this being entirely due to the new cervical diagnosis. Dr. Gantwerker, Adi and I had a consultation, and thus decided that it was time to move forward with fixing the issue, with a C6/C7 disc replacement. Unlike the lumbar disc which was plastic and titanium, this one is actually ceramic and titanium. And most importantly, just like my lumbar surgery, should allow me to recover completely without limitations at the end of the road, later this year. And unlike the lumbar surgery, this is a much shorter ninety-minute operation, which should help prevent some of the effects the anesthesia had on my body. But to be safe, we will involve my urologist and GI and pain specialist in advance, so we are ready. And he’s promised I’ll wake up with a catheter so I won’t have to go through the experience of getting one inserted again, and after one or two nights in the hospital, I should be able to go home without wearing any contraptions, hooray!

Am I scared? Sure, I wouldn’t be human if I wasn’t. But I am also completely confident that this is the right course of action for me and my family, and that there’s nobody I would feel more comfortable doing my surgery than my medical team.

But now it’s time to take a sharp left turn and tell you the weirdest thing to happen to me in a very long time. In the middle of all of this craziness of the last few weeks, I caught COVID. But I didn’t. Wait, did I? Okay, here is the story…Natalia got some sort of cold, we knew it wasn’t COVID after a million negative antigen and PCR tests, so great, just a cold. But then a few days later I caught her cold, but needed to be sure it was the same thing – which obviously it would be, but had to be sure, right? So, I did a few home and lab tests over the next few days, and everything was negative, great, moving on with life. Except, then this phone call happened:

THEM – Hi this is the LA Department of Public Health calling for Boaz Hepner.

(I then verified that it was really them and not the start of some scam phone call)

ME – So how can I help you?

THEM – We just wanted to see how you’re feeling.

ME – My…back? I’m confused

THEM – No, with your…. COVID.

ME – HUH? I don’t have COVID, what are you talking about?

THEM – We were notified last night that you tested positive on…. March 3rd with a PCR. Did nobody notify you?

ME – Seriously? NO! I was told everything was negative and I never got contacted about the PCR actually. This is really not cool, that test was over FIVE DAYS AGO!

THEM – Yes, this is really awkward because we’re not supposed to notify people about it, we’re just supposed to follow up and offer guidance or assistance and help contact trace if necessary.

Me immediately after LADPH phone call, taking the first of many negative tests

I went on to explain how annoyed I was about finding out this way, way too late, and now I had to notify everyone I was with the past five days; and honestly it didn’t make sense to me given that I never got the test result. So, here’s what I did: I emailed the lab itself demanding the test result, and got my entire family tested in the meantime. The rapid tests were all negative, cool-cool. Then I got the email back from the lab with the test results, and sure enough it showed it was positive. So, what did I do next? I emailed back irritated saying, “WHY DID NOBODY AT THE LAB NOTIFY ME OF THIS?”, and to their credit, they actually replied to me with the following, verbatim, “Hi Boaz, a system error occurred in our laboratory a few days ago. We sincerely apologize for any inconvenience this has caused. Rest assured that we will do everything possible to ensure that this does not happen again in the future.”

Natalia getting tested as a result of this LADPH phone call, and as always, finding the “nose tickle” tests hilarious

This didn’t satisfy me at all, because if there’s a lab error, how do I know if the result was affected, and accurate? I then pushed for that answer but got no further response. The next day, my PCR was negative, which all but confirmed what I had started to suspect – it was a false positive, due to the lab error. How do I know this? First of all, PCR tests usually stay positive for weeks at a time, well past the point where they are relevant. Secondly, I had earlier PCR tests that were all negative thanks to my procedures. And lastly, the lab literally confirmed they had some sort of error, albeit without clarifying what that entailed. I confirmed this with my infectious disease contact, who agreed this was a lab error. So here I am, vaccine educator for my hospital, one of the main points of contact for people with questions about this stuff in the LA community – frequently telling others that false negatives are common but false positives are quite rare – and I get an extremely unusual false positive PCR due to a lab error. I’m sorry Alanis, but that is actually an example of ironic.

To wrap this all up, what is the biggest reason I am relieved? Two-fold: I was going to have to miss my nephew’s Bar Mitzvah during our isolation, and my surgery is coming up, and if I have a positive PCR test prior to surgery, it will be canceled. For a day I strongly feared that my recovery would be delayed much further; but once again I get to finish on a positive note, as I just enjoyed a wonderful weekend with my family for the Bar Mitzvah, and this next surgery is set for the 28th. I am scared, but mostly I’m looking forward to getting one huge leap closer to my full recovery.

At the end of the Bar Mitzvah weekend with some of the visiting east coast family members
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