Cipro, Levaquin and my shattered left ankle

Cipro , Levaquin and my shattered left ankle

-thanks Public Citizen, CNN and Google

My left ankle shattered about 10 a.m. Saturday, April 5, 2008. I have no memory of the event.

I last remember sitting back in bed to finish the newspaper. During the period I cannot recall, I apparently was able to function despite what must have been intense pain as my husband found me screaming on my bedroom floor. Upon becoming aware of my circumstances about two hours later in the ER at the Ocala Regional Medical Center with my left foot extended in an unnatural position (“ fall injury with severely displaced distal ankle fracture”), I asked to speak with my husband. The attending nurse said I had already done so three times and neighbors later reported that I had spoken to them as the ambulance took me away. I had no difficulty recalling telephone numbers during and following my black out.

After an x-ray, CT scan and MRI of my brain along with a cursory interview with a neurologist (Dr. Nieves), the surgeon (Dr. Nirav Gupta) put a plate and a couple of screws in my left ankle the next day. Operative report describes procedure as “open reduction and internal fixation of lateral malleolus and medial malleolus ankle, left side.”

Following my hospitalization and several weeks at the TimberRidge rehab center, I insisted on seeing another neurologist in an effort to determine just what precipitated this event so that I wouldn’t again injure myself or possibly others should I be driving at the time. The second neurologist (Dr. Jose Gaudier) did an exhaustive interview (with my husband present) and ordered a carotid artery examination and an EEG of my brain. Again, nothing abnormal was found.

On July 9, 2008 I heard Dr. Sanjay Gupta report on the links between Cipro and broken tendons and other injuries the day after the FDA issued its “black box warning.” Public Citizen had requested such a warning in August 2006 and Dr. Gupta said on his broadcast that doctors have known about the dangers of the drug since 1992. The FDA approved Cipro for use in 2000 and Levaquin in 1996. None of the doctors who’ve seen me have mentioned, suggested or even implied any causal possibility between use of Cipro and/or Levaquin and the injury I endured. Moreover, after googling the drugs and ankle injuries, I found that there are literally hundreds of personal reports of injury similar to that which I have.

Despite a predisposition to avoid unnecessary drugs, I had not earlier connected repeated use of Cipro and more recently Levaquin to my accident. I simply ascribed the following to stress as a caregiver for an extended period.

Before my Father died May 1, 2005, I experienced difficulty stepping out of bed because of pain on the bottom of my left foot. I could not even go to the bathroom without wearing shoes. . More recently I have had trouble standing at peace rallies and walking my dog. I also have felt faint at various meetings and luncheons. . Occasionally the pain on the bottom of my left foot upon getting out of bed recurred. I simply chalked up these episodes to my exhaustion in caring for a disabled husband who is unable to contribute much to running the household and to my activities in the community. Fatigue has been a constant in my life for many years along with shortness of breath and general lassitude.

During recent years I have taken Cipro fairly frequently for recurring urinary tract infections. Last November when an infection did not respond to Cipro my internist, Dr. Jose Roman , sent me to a(n) urologist, Dr. Paul Jo, who prescribed Levaquin.. Because the infection had persisted and I wanted to rid myself of it, I took the Levaquin DESPITE the fact that I experienced considerably more severe pain on the bottom of my left foot than I ever had before. Since Dr Jo gave me a prescription with 12 renewals (?) I took Levaquin again when a UT infection recurred yet again in February, I believe.

In the months just prior to my accident I also experienced several very brief transient surges in my brain like flashes of electrical charges – basically the left rear quadrant as I recall. Then about a week or ten days before the accident I had an earache on the left side which later extended into my left jaw . I’ve had good dental care and the only thing wrong with my mouth is that a crown has fallen off a tooth. But my husband, a disabled dentist, said there was no cause for concern as it could not be a source of infection since it had a root canal. Nevertheless I went to see a dentist, Dr. Stephen Dunn ,on March 27, I believe. Dr. Dunn, after taking new x-rays, concurred with my husband’s assessment. However he said that if the pain continued he would send me to a neurologist in case I had trigeminal neuralgia. I was first to return to Dr. Dunn about ten days later. After reading about trigeminal neuralgia online and because the pain had subsided, I knew I had not experienced this disorder. The accident occurred before I was able to return to the dentist.

Please note that I was again taking Levaquin for the recurring urinary tract infection.. . When I got to the rehab center the attending physician (Dr. Gabriel Umana) put me back on Cipro because he said that it was the standard for UT.

I’ve since had much outpatient therapy but still am not able to walk well and the foot/ankle remains in large part immobile ( like concrete as one therapist observed), swollen with scarring and a protrusion on the right side where the screws were inserted. Surgeon who I see again July 24 opined that injuries such as mine take 9 months to a year for recovery although he acknowledged that the ankle will not ever be entirely normal. My surgeon and the therapists said that any injury to the foot is the most difficult to recover from (worse than hip, pelvic fractures) because the foot bears the weight of the entire body.

Although I am now 72 years of age, my parents were long-lived. They both walked every day with my Father even mowing the lawn up north until he was 98. My Father died totally competent just three weeks short of 100 and my Mother died at age 91 of breast cancer which had metastasized. Thus I have expectations of living another 20 years or so, especially given the fact that I have always been well fed, have always had good medical attention and have never indulged in personal excesses of any kind. Dr. Roman, our internist since moving to Ocala in September of 2000, has always authorized routine checkups and appropriate tests for whatever ailment I may have had over these years including a bone density test just months before the accident.

I have learned that there is an array of drugs which were used effectively for urinary tract infections before Cipro and Levaquin were put on the market. Apart from the pain and disruption to both my husband and my lives and the psychic and financial costs involved thus far, I am most appalled at the prospect of circumscribed use of my legs for the rest of my life . I hobble around the house, I can’t garden as I used to and my golden retriever breaks my heart by bringing me her leash for a walk.

I suddenly am old.

Delphine in a Persian Wonderland

You don’t have to leave the United States to experience culture shock. Just go to Washington and find a job on Embassy Row.

You might wind up, as I did , spending all your waking hours almost totally immersed in another culture while working for a glamorous

Middle Eastern ambassador whose lavish parties and playboy persona captivated the city for a number of years.

Ardeshir Zahedi, the Shah of Iran’s last ambassador to the United States, anticipated the Reagan era by mixing aging Hollywood legends with a medley of Washington insiders, international sophisticates and all-American heroes including leading quarterbacks and media megastars.

Despite revisionist reports after the revolution which deposed the Shah in 1979, almost anyone who was anybody considered an invitation to

the Imperial Embassy of Iran more exciting and desirable than one to the White House. Official Washington flocked to parties where women, perhaps for the first time in their lives, enjoyed compliments and courtesies of the kind that now occur only in historical novels. They took it all at face value while their husbands happily acceded to any business boons born of an economy bursting from the profits of the sky-rocketing price of oil.

Caviar and champagne flowed freely in salons whose gilded walls and chandeliers suggested Versailles. And in the Persian Room, a vaulted chamber with a ceiling of a million miniature mirrors, a single lighted candle could transport one on priceless carpets through prisms of magical infinity back to the nights of Scheherazade.

But more seductive were the Iranians themselves. The ambassador’s charisma was of the first magnitude and his aides easily beguiled with courtly charm and chivalrous solicitude. Any every woman, no matter her age or visage, was “beautiful, beautiful” mainly because the ambassador could not remember her name. Soon I found myself writing love letters to women all over the world, often regaling members of the staff with my flights of poetic fancy.

But one had to remember that these parties never were without purpose. This was a working embassy which functioned as the principal public relations arm of the Pahlavi dynasty. Internally, it was much like a miniature royal court in which flatterers and prevaricators often prevailed. Standards which pertained to westerners did not apply to Iranian nationals.

Embassy guests would recount stories of the Ambassador’s kindnesses and humility, not knowing of the terror he inspired among the Iranians whom he often devastated verbally. Thus “tuqui’a” or dissimulation

Was not considered duplicitous, merely a prudent means for survival.

It wasn’t easy for a woman from small town USA who, despite a number of years overseas with the U.S. diplomatic service, was still fairly puritanical and politically naïve.

However, as a “local employee” one quickly became an in-house expert on everything from procurement to press relations. Since I could find my way around the yellow pages and knew the difference between a credit and a bill, my reputation was very soon secured. My greatest coup occurred when I was able to obtain a part for the Shah’s yacht which had eluded the rest of the staff for almost two years. The ruler of Iran may have been Kings of Kings, Light of Lights and Center of the Universe to the Persians but the Florida shipbuilder refused to tolerate the imperiousness of the demands of his vassals.

Soon I was dealing with the White House and the Congress and the State Department and the press and every businessman and charlatan who wanted a piece of the oil action. My politicization progressed rapidly. I read the newspapers with amusement and increasing cynicism as there often would be a significant disparity between the information I had and that a reporter thought he had. Even the most knowledgeable journalists found their vision clouded by relationships which too quickly became too intimate.

While it was fascinating to deal with the outside world, the greater challenge came within the embassy. It was there that one paid for the opportunity to observe the movers and shakers and shysters without.

Morning logistics were an exercise in non-western inefficiency. As a foreigner, I never was given a key to the ambassador’s suite despite the fact that I spent many long hours alone. Though I usually arrived a few minutes after nine, neither the Iranian social secretary nor the official in charge of the ambassador’s anteroom would be expected for another half hour or so. Thus every morning, it seemed, the telephone operator would have to send for the wonderful Italian houseman to open the door. Oftentimes he had to be awakened because if the ambassador was in town, he would have had to remain available for the private parties at the Residence next door, parties which, I was told, often lasted until early morning.

I would begin reading the newspapers in order to anticipate anything which might require attention. Members of the staff would telephone or appear to bow and inquire about the ambassador’s “mood.” Zahedi’s

mood determined the tenor of the day for some hundred and twenty people. Of that number, perhaps a dozen or fewer actually would cross his path but ramifications of his disposition reverberated throughout the building.

The ambassador would convey to “his people” his first instructions of the day. Who was to be sent caviar, who flowers or perhaps a small gold coin, a “Pahlavi”, for the hospitality of the evening past. Cars had to be dispatched and the chauffeurs given detailed instructions on how to find, say the White House or the Capitol, even if they had been there just the day before. Patience never was one of my strong suits but the good nature drivers voluntarily gassed up my Camaro during the oil crisis of 1973-74 (?) , saving me from the long lines which countless other Americans endured.

If the ambassador was in town, the office I shared with Jaleh Yazdan-Panah was transformed into a maelstrom of mayhem. The comings and

Goings from his office and the hangers-on sitting nearby in order to rise and bow should he chance to pass meant working in a vortex of cacophonic volume as Farsi-speakers generally conversed only at the top of their lungs. The administrative officer to whom I had reported for the first six weeks or so once accused me of having no “taruffe,” the Farsi word for courtesy, because when I was on the telephone, I would sometimes turn my back in an effort to hear when three or four people spoke to me simultaneously while a dozen others continued their conversations in the background.

Basically each supplicant said “If we’re friends, you’ll do my project first.” Everything was put on a personal basis. So unless the ambassador wanted something specific, I had to establish my own priorities.

Because of the nonstop phone calls and the pandemonium which prevailed, I usually stayed after hours to do the correspondence in the silence which descended once the ambassador departed. In addition to the normal business of an embassy, I remembered birthdays, I wrote thank yous for thank yous. I sent out little gifts with a note to just about everyone the ambassador met on his extensive travels around the country.

And I became an excellent sleuth. For example, the ambassador might have met a woman in a green dress. He couldn’t remember her name, which party, which city, which date. So you play dumb and call around to chat with all his hostesses for the past few weeks.

Washington socialites themselves could provide a source of considerable amusement within the office. Jaleh would hear tales of women shopping for a dress with which to seduce the ambassador, . . hostesses would call us demanding dinner parties for 48 at the Residence when no more than half that number could be accommodated.

Upon the arrival from Tehran of one of the ambassador’s relatives, women besieged the newcomer with invitations under the assumption that he had special influence. In fact, the ambassador literally did not even glance in his direction for some two months, so furious was he at the behavior which occasioned banishment from the Imperial Court.

But bloodlines were always the bottom line so the malefactor suffered only psychic distress.

Iranians love to give gifts but they are not nearly as generous with information. If you knew something that no one else did, you in effect forced the ambassador to call upon you. My efforts to Americanize the place included the distribution of copies of correspondence to those who I thought needed to know, a revolutionary act at the time.

There was a clear distinction between the treatment accorded westerners and Iranians. Fortunately, I seldom had to deal with Iranians outside the embassy who may have traveled from California, Europe or even Iran to meet with the ambassador only to be kept waiting for days or never even seen at all. However, appointments with westerners, be they statesmen or students, were punctual to the minute unless the ambassador happened to be on the telephone with the Shah.

As a foreigner, no matter how much you gave of yourself, y ou were always the outsider, always the “ferenghi.” You never really were privy to what really is going on but you do the best you can given the information available to you at any given point in time. But if the Secretary of State doesn’t return the ambassador’s call, somehow it’s your fault. If the telephone lines are cut when the ambassador is speaking to Switzerland, it wouldn’t have happened if you hadn’t answered other calls. The ambassador read people extremely well, but things mechanical were another matter.

Nevertheless I was never treated discourteously. Otherwise I would not have remained as long as I did. True, I resigned repeatedly but not because of the ambassador whom I came to respect and admire. Sometimes the internal machinations simply became too much of a daily struggle.

My penultimate resignation letter stated that it was too difficult for me as a woman in a Muslim environment and as a ferenghi who would never be trusted.

The ambassador’s response upon his return from Switzerland moved me deeply. I was summoned to his suite at the Waldorf Towers where he went over a few weeks’ backlog with me in the presence of his principal subordinates. They included the Iranian Consul General in New York City, the head of SAVAK in the United States, the representative of the National Iranian Oil Company and the Embassy’s Minister Counselor for Cultural Affairs.

When we departed the following day, I to return to Washington and the ambassador to Houston where his sister was hospitalized, he took me to the airport in his limousine, leaving the others to follow in another.

Soon after his return to Washington, Ambassador Zahedi called me to his office. He said he had decided to give me a private office directly above his own, with a staircase to be built connecting the two rooms. I also was to have my own assistant and I would be among those on Iran Air’s inaugural flight from New York to Tehran.

When this became general knowledge within the embassy, the friendship and respect of many turned to envy and hostility. My position as a conduit of the ambassador’s wishes was increasingly denied. One evening I went back to the kitchen to check on matters for the evening reception only to find myself locked out of my office upon my return.

A dam born of frustration and exhaustion broke and I left a furious letter of resignation on the ambassador’s desk. It began “I’m tired of working in this den of vipers….”.

Thus ended three years during which I had the privilege of working for a highly idiosyncratic but truly remarkable man whose loyalty to his leader was more profound than any I have ever observed. His cultural background, personal lifestyle and political imperatives were nothing like my own. But Ardeshir Zahedi’s humanity was immense and his behavior of much grander dimension than that of the world about him.

An astute observer remarked that I had allowed myself to be defeated by pygmies.