Progressing Well!

At five weeks out, I'm doing really well -- no pain, able to put my foot down a bit for balance and toe-touch a bit while using the walker. I'm about a week ahead of schedule (compared to the last one, anyway).  We took one of the wedges out of the boot over the weekend, so I'm chugging right along!

Hopefully, I'll be able to start walking in the boot in the next few weeks. I have a followup appointment in two weeks, which is probably when he'll give me the go-ahead to start clomping about. I hope so!

I'm getting tired of the scooter, but I'm trying very hard to be a compliant patient and not start walking on my foot too early. I really wish that I could drive, though. The "can't leave the house" is beginning to make me a bit crazy. If I could drive, being stuck at home isn't a big deal -- but with the boot on the right foot this time, I can't fit into Mark's car and can't drive safely. Mark is being very patient, though, and hauling me around on demand with good grace. I know it's hard when he's been at work all day, to come home and then turn around immediately and head back out somewhere. But he's pretty cheerful about it. I'm sure he'll be relieved when my "must go OUT OUT OUT" demands slow down.

We're heading up skiing in two weeks (well, Mark will ski, I'll lounge about like a lump),  Hopefully we'll have snow!

Drooling in my Sleep

Stitches out today -- well, stitch, not stichES -- one long spiral of prolene. On the last foot, the stitches were the worst part of the whole thing, hurt like hell!

This time, much easier. The surgeon took the stitches out a week earlier, and I took a valium before the appointment.

All I can say is, people take this stuff during the DAY? Oy. I fuzzed out half way through my appointment and fell asleep immediately when I got home. I woke up four hours later int he recliner, keyboard in my lap, and drooling. Not doing that again!

I'm supposed to take a wedge out of the boot in a week or so, and wait at least that long before soaking my foot. So far, things have been going well!

Officially in The Boot again

First followup appointment today, 10 days out -- things look great, the surgeon thinks I'm ahead of the curve, and I'm officially in the boot and out of the cast.

He thinks that it's because of the ice-water circulator (a nifty little pad that pumps ice water around my foot instead of using ice packs or bags of frozen peas like we did with the first one).  I've been sitting with my foot up and the ice-thing circulated most of the day. My foot isn't swollen, my toes move easily, the incision looks great. He thinks he'll be able to take the stitches out at three weeks instead of four this time. Which means my Christmas present from my surgeon is A BATH.

This is a good thing, trust me! I desperately want a bath. Mmmmmmmm.

The Living Room look the Same

Did you know that there is a television show called Knitting Daily?

A television show. About knitting.

And it's just as exciting as you would imagine!

I've been to the OUT!

I feel pretty bad that it is The Husbands birthday today and I'm pretty much not able to do anything for him -- I planned ahead a little and got him his gift earlier this week, but we can't really go out anyplace nice, etc. He's being really nice about it ("We'll just postpone and do something when you are able to get around"), but I feel awful.

We did get out of the house for dinner (just a local place we love), and it was enhausting for me. He's been hiding in his office for the day, and I feel like a schmuck.

But I CAN get out of the house, which is a plus!  Not quite able to do it by myself, but t least get in the car and be chauffeured around. :)

Happy Birthday, Adorable Husband! I promise to make it up to you when I can actually DO stuff!

Yay, Sports!

So, when people talk about watching "the game" over the weekend, I am always confused. What game? Which sport? Wha?

Is it the one where they do the thing with the ball?

This t-shirt sums up my approach to sports perfectly:

...and the boredom sets in

Well, five days in and I'm bored. Boooo-rrrreed. I have my computer setup in the living room, an endless supply of television shows on Hulu, and I'm still bored. This is going to be a long few months.

But I'm mostly off the pain meds, just relying on the ice-water pump for my foot, and things seem to be going well. I was worried for a bit, since it hurt a lot more than the other foot did initially, but it's settled down.

I've been rather compulsively reading travel books and websites for Iceland (we're going in May), and binge-watching recent tv shows and movies. I'm getting around a bit better -- still slow and a bit tentative, but I haven't had any issues.

So far, so good!!

Becoming an atomic clock!

Well, the nerve-block wore off completely overnight and when I woke up, my foot was definitely not numb, and definitely hurt. Ow!

For my left foot, the nerve block lasted almost 48 hours (which freaked me out a bit, since I couldn't move my foot at all), and by the time I finally got feeling back in my foot, things really didn't hurt too much. This time? Things hurt a bit sooner -- and I have developed the ability to track time down to the minute:  at four hours, the percoset wears off and I am summoning The Husband for more. He is doling them out, since I forget that I even took one.

The surgeon gave me percoset again, for a day or two and also prescribed Valium for muscle spasms, which is new. I haven't had muscle spasms, but I think it's his response to my normal complain of "it doesn't really hurt, just...can't get comfortable". Apparently that is my presentation of pain and they think that a minor dis-associative will help. I haven't taken it yet, so I don't know.

So I spent the day in the chair, binge-watching BBC documentaries and web-surfing. The ice-water pump thing is working admirably -- wish I'd had it for the other foot, it really is better than a series of ice-packs changed every half-hour or so. 

But so far, so good. Hopefully this one will be as straightforward as the left heel. They took off a bone spur "the size of a nilla wafer", according to my surgeon. My right heel was always the worse of the two, the bump on my heel was much bigger on that one, and I had problems with it earlier than I did the left foot. But it's also my dominant foot (which is one of the reasons we did surgery on the left foot first -- at least the working foot would be the good one!

Off to bed!

Second Surgery Done!

Dragged ourselves out of the house at 5:30, the same team that did my first surgery wrapped this one up in record time and I was back at home by 10:30. Mark is taking a whole week off to wait on me hand and foot!

This time, they wrapped an ice-water circulating pack around my foot, with a little pump thing to keep water cooling my foot (no ice packs!), so I'm sitting here tethered to the tiny pump and my foot is wrapped up to mimic an elephant's foot. It's huge!

The nerve block didn't "take" as well as the last one and I could move my toes and my foot hurt when I first woke up from anesthesia, but things have settled down. Remember last time? My leg from the knee down was totally, completely numb for two whole days -- freaked me out!

I pretty much slept all day in the chair. Snoring quietly, if my husband is to be believed.  I'm going with "snoring like a rhino", if my waking myself up is any indication, but he was trying to be nice! A bit of a sore throat from the intubation, but that's it. Not nauseous or anything, which is good. I have never had nausea from anesthesia (knock on wood!)

I can, with a bit of work and supervision, make it to the bathroom.  It's a bit more complicated (turn off pump thing -- for which Mark installed an actual SWITCH on The Chair, disconnect hoses, etc), but I can manage. I was worried that having my dominant foot being the "off" foot was going to be a problem but so far I seem to be doing ok.

Except....

I cannot get into our bed with my right foot out of commission. I sleep on the right side of the bed, and our bed is very tall -- getting in is a bit of a gymastic leap and I can only do it from my right foot. I tried getting in the same way on Mark's side...no go. Definitely not graceful. I may have to sleep in the other room until I'm a bit more agile. I practiced a bunch before surgery and while I might be able to struggle into the bed, it is not easy. Hmph. Mark is building a step that might help me boost my way up into the bed. Maybe. Although today I am a bit too uncoordinated to try it, I think.

Mashed potatoes for dinner (yeah! for Thanksgiving leftovers!) and napping in the chair. At least I got a free month of Hulu to watch All The Shows while I sit here, bored.

....and the other one!

Just popping back in that I'm up on the surgeried foot (still hobbling a bit, but walking!) and my second surgery is scheduled for Tuesday, December 1.

Oooh.

Yeah.

Can you just FEEL the enthusiasm?  I've been waffling between "yup, do it as soon as possible" and "never, never again".  Obviously, "do it now" won. Ugh.

The previous surgery went really well, I have stiffness and muscle atrophy, but no real pain my fixed foot, and I want to be back working out and walking in a few months. This sitting on my butt unable to do anything got very, very old.

So! Off to surgery tomorrow. I'll try to post updates as I can!

Six weeks post-surgery

Had my six week follow-up appointment today and things look really good. Incision is healed well, swelling is down, everything feels well-attached and proper.  The doc moved my foot all over and now it aches a bit, but otherwise I have permission to start putting my toe down and doing a teensy bit of weight-bearing. I'm allowed to put my booted foot on the floor for balance, and can touch it down if I'm using the walker, but no real pressure yet.

I also have removed one of the wedges from the boot, so my foot is a tiny bit more flexed and I'm starting to stretch out the tendon just a bit. I can do range-of-motion exercises now, too. Those are pretty self-limiting --- move my foot up and down, side-to-side, around in circles and if it pinches or hurts, back off. That's a relief, actually; lately, the urge to twitch and move my foot have been almost irresistible. I've been trying so hard to do exactly what the surgeon ordered (do not move foot! do not flex ankle! elevate! No weight bearing!) and it was starting to be an all-consuming obsession.

I know I move my foot at night when I sleep, but now I can do it purposefully and not worry about it. Weird when that sort of thing makes you happy, isn't it?

And I have the OK to switch over to ibuprofen (Advil) instead of Tylenol. Initially, they don't want you taking an anti-inflammatory while the tendon is starting to re-attach; it can cause issues with healing, I guess, since there is so little blood flow to the tendon and the heel. But Tylenol doesn't do squat for me except give me a sour stomach. It doesn't even kick a headache. So if it was taking the edge off the ache in my heel, it didn't seem to be doing it very well. I'm allowed to go back to ibuprofen regularly for a week to see if it helps. I'm hoping that it does, and that it lets me sleep better. I've just been sort of twitchy and restless at night, and not sleeping very well. Mark thinks it's because it does hurt more than I'm recognizing and that sort of achy-can't-get-comfortable feeling is how I register pain. Go figure. I wouldn't say that things hurt, but if I think about it, I'm acutely aware of my heel and that it aches and twinges. Getting rid of that distraction will hopefully let me sleep better. Here's hoping!


Four weeks until my next followup, when I should be able to remove the rest of the wedges in the boot and start weight bearing a bit more. The estimate is that it will be 6 weeks until I'm walking in the boot vs hobbling, and then another month or more before I'm bootless. Definitely a conservative plan, but we'll see how it progresses once I start PT and strength exercises after the next review. I'm figuring I should be walking in about five months or so -- which matches up with the estimates I saw online, and what my surgeon discussed with me.

And then I get to do the OTHER foot!  The criteria is that I have to be able to hop and stand on my toes with the left foot before I can have surgery on the other one. I'm having a hard time with that sometimes now, with achilles tendonosis in my right heel causing problem sometimes. There are days when I can't raise myself up on my toes, which makes everything harder.

Mark is installing a grab bar on the garage so that I have an easier time getting down the two steps from the porch to the garage door. That will help now that I can maneuver myself out to the car and drive (his car only -- mine is a stick shift!). It's a hassle, and I'm very slow, but it's good to be able to do it myself.

Can I come into the Out Now?

Lazy weekend, spent most of it watching TV and doing crossword puzzles -- I can't seem to sleep in, for the last few weeks I've had a hard time sleeping. It's not so much a problem with falling asleep, but I think I'm just uncomfortable enough that when I get through a sleep cycle (about 90-100 minutes for me), I actually wake up enough to be, well, awake.

Instead of just rolling over and falling back to sleep immediately, I have to wake up enough to roll over without bashing or bending my foot. Or I try it without fully waking up and something zaps me in my heel or ankle and I am Awake Right Now. It's annoying. It's particularly annoying because once I wake up enough to do that, I wake up enough to have to pee. Seriously. Never in my life have I been able to roll back over and go back to sleep if I even have the barest hint of  a thought that I need to go to the bathroom. So, foot twinges, I wake up to roll over and then...well, crud. Sit up, find and put on the boot, maneuver the scooter to the bathroom and voila! I am up and can't quite fall back to sleep. So I lie there for a half hour or more, staring at the wall and trying to get comfortable.

I mean, I love sleeping without the boot -- SO much easier than trying to flop the giant plastic and foam cast around -- but I am just not sleeping well. Benadryl at night seems to help, a little. Well, the vicodin does, too, but I don't want to take that unless things hurt and they don't really. They are just...uncomfortable. I toss and turn a bit and end up sleeping in the same position, which makes me stiff and sore in the morning.

But my foot is feeling better --after soaking yesterday and scrubbing all the dry skin of my foot and leg, I was sitting in the chair and my foot just felt like it was tight, like the skin was too tight. I really think that it was just so dry and "new" that it hurt to move. Which is why it's surprising that it took a few hours to think "oh! Lotion!" and slather the stuff on like it was going out of style. Seemed to help a bit, although my toes are swollen enough that touching them is uncomfortable. Wiggling them a lot helped, too.

Spent more time today with my foot unwrapped and airing out. Mark is a bit worried that I might have a pressure sore on the top of my foot, but it seems to look better today. Not being able to move my foot much is beginning to be a problem--I want to roll my foot around, and I'd really like to confirm that the flaccid calf muscle will still work. Even a twitch right now makes my heel hurt, so I am trying to ignore the urge to move my foot around when it's not in the boot. I'm really looking forward to the surgeon's ok to start to try to move it a bit. (Although I'm also dreading it -- I don't know if it will hurt or not, and I'm a bit terrified of having pain like I did when I fell).

We watched the animated movie "Home" --quite cute, and the main character (and alien named Oh) has a scene where he's locked in a freezer, and asked, "Can I come into the Out now?" That's how I feel every day...I'm getting heartily sick of the view from my recliner. I want to be OUT of the house, even to just drive to the gas station. I don't care! OUT!

Yup, cabin fever has set in. Argh!

Everything can be solved with Hot Water

I was finally allowed, after FOUR weeks and finally getting the stitches removed, to get the incision wet and actually soak in the bathtub. This feels like the first real hygiene I've had since surgery. (It's not, but it sure feels like it!)

Not a sit-on-the-shower-chair affair with my foot in the giant baggie, trying to wash while sitting and holding the shower sprayer, not a washcloth-and-towel sort-of wash, but a full-on, soak in the bathtub until I was pruney BATH!

It was AWESOME.

I had to drain and refill the tub twice, but I am scrubbed and exfoliated (which was a wee bit gross, what with my foot in the bandages and boot for the last month) and clean! We have a bit soaker tub in our bathroom, so I had a pretty easy time getting into the bathtub. Mark supervised.

Getting out was a bit harder, but I can still manage it if I'm very careful. I'm just so paranoid of doing anything without the boot on, that it's hard to maneuver without the boot and not bash or twist or press on my foot. My poor leg is all skinny and atrophied (no movement at all for a month, I hope it remembers what to do in two weeks when I can start moving my ankle!) but it is at least hairless now.

Mark says the incision looks good, and I'm sitting in the chair letting my foot air out and dry. But I get queasy looking at the incision, so he has helpfully draped it with a washcloth so I don't have to see it.

It's pretty funny, actually. I am just a wuss.

I will need to replace the ace bandage to help with swelling, but at the moment, I have a big bruise on the top of my foot where the bandage was apparently a little too tight. I don't think it was the boot -- it's not in a place where the velcro straps cut across my foot, but I'm going to keep both the bandage off and the boot for as long as I can bear sitting here in the chair. My toes are a bit swollen and feel sort of sausage-y, but otherwise look pretty good

And now for those who like watching the surgery channel, the actual incision:

It doesn't actually look too bad (and for some reason, looking at the pictures doesn't make me want to hurl, just the live foot does that.

I don't see the surgeon again for another week and half (at full six weeks after surgery) and hopefully the next step will be to start doing some weight-bearing and starting to stretch the tendon back so I can stand flat-footed. Right now, my foot is pointed at a "neutral angle" and I am not supposed to pull on the heel at all. That process will take 4-6 weeks as well. He's being very conservative, but I'd rather be slow and sure than risk damaging something or having a ton of pain.

4 Weeks Post Surgery

Woot! A Month out -- things are going well. I went in this afternoon to have the stitches taken out (finally!)

OW OW OW OW OW! Seriously, that HURT. I wasn't expecting it to; the only other time I've had stitches that needed to be removed, they were old-fashioned, single-stitch silk. Taking those out was simple: clip the stitch and tug the 1/4" or so of thread out.

Not so much with my heel. I hadn't taken a really good look at it (since stitches in general make me a bit queasy), but it was stitched subcutaneously with one long length of prolene (a sort of non-absorbable polypropolene thread). So, pulling out the stitches was really pulling out this really long length of fishing line that was spiralled into the incision. Hurt like hell and lit up all the nerve endings in my foot.  I only cried a little bit.

But everything looks good (although my left calf is skinny and atrophied because I'm 100% non-weight-bearing. It's going to be funny looking when I finally take off the boot. I have another follow-up in two weeks -- and still no walking on my left foot. Hopefully I'll get the go-ahead to start toe-touching and putting a bit of weight on the foot and starting the process to work my way down from the four wedges in the boot (to keep my foot at a neutral, to-pointing angle) to a normal flat-footed step.

Slow progress, but progress! That is good!

I am really getting tired of the view of my living room from the recliner. Poor Mark is met at the door with "where are we going OUT OUT OUT tonight? Get me OUT of the house!"

Three Week post-op

Follow-up appointment today, ostensibly to remove the stitches (which, I must admit, are beginning to itch a little bit --worse now that I had the initial thought "ooh, that itches just a little..." now it's all I can think about).  But my surgeon decided to leave them in place for another week. Heels (and feet in general) don't have a ton of blood-flow to the skin and so any incisions are very slow to heal and need much babying and care.  Everything looks good -- incision is clean, heel is pink, not too much swelling.

So, Mark got to review the MRI from last week (which is pretty cool, I must say), and we both got to look at the "after" xrays and see just how much bone he removed from my heel to get the bone spurs and Haglund's deformity removed.  I should have copies of them soon, I'll post them when we get the CDs.

But -- and here's the fabulous news! -- after much begging and reassuring him that I promise to wear The Boot every other moment of the day, I have been cleared to sleep without the boot! He figures that if my fall didn't do any damage, what could I possibly do while sleeping? If I try to move it in a way that is not good, it will wake me up.

Slightly less gruesome pictures this week -- things are less purple-y and freaky. I still have strings of stitches (which I must admit make me very queasy and barfy. I hate stitches. And my foot is still vaguely orange-ish from the betadine, since I haven't been able to get my foot wet at all. I'm  just a little bruised.

And, three weeks in the cast and boot and my left leg is all skinny and atrophied. But I don't have a lot of swelling in my foot, which is good. Back into the elastic bandage and into the boot we go!

Good New for a Change!

Good news!  My MRI results look good -- evidence of healing, and NO TEARS in the achilles. When I fell, I apparently did not step down on the foot (or if I did, nothing bad happened except pain).

No second surgery to repair things and I'm on track. Woot!!

Next appointment is on Wednesday, 3 weeks post-surgery. I'm still no-weight-bearing (and assume I will be for another week or two at least). But things are ok! Yeah!

No incidents today!

I managed to successfully take a shower without falling, slipping, banging, or otherwise damaging myself. Yeah!!

Of course, the Adorable Husband was there the whole time and it took 45 minutes, but I feel. so much better! Whoever tells you that 'bathing' with a washcloth and washing your hair in the sink is good enough---lies. It's not. After a few days you feel awful and grimy and disgusting.

I cannot wait until I have the stitches out (Wednesday this week) and I can take a shower without the waterproof baggie thing, or even soak in the bathtub. The problem with a bath is that I don't think I can lever myself out of the bathtub...it's one of those huge soaker affairs and it's hard enough to get out of on a good day!

OK, Universe, enough!

I surrender. The universe obviously has it in for me. No more.

I'm doing ok, still waiting for results from my MRI, but otherwise same-old, same-old. Things hurt a bit, I'm annoyed an uncomfortable, but all is going ok.

The Adorable Husband, however, called me at three o'clock yesterday to tell me that he was on the way to the ER because he was in A-Fib (Atrial Fibrilliation) and needed to be cardioverted. This is the first time he's had an issue in almost 9 years, and the fourth time he's had to be shocked back into a normal rhythm.  Aaargh! Seriously? We need another thing wrong this week?

He's fine -- they do it under general anesthesia and he was home by seven and looking and feeling fine. My nerves are shot, but other than being a bit tired, he is ok and back to work this morning.

So, that's it. Nothing else can happen. One person having issues is enough!

Day 14 - Insurance Annoyance

I've been icing and elevating, and my heel is feeling ok -- no more painful than it was before, mostly.A twinge now and then, but doing ok. I'm hoping that this is a good sign; that this means I didn't rupture or tear anything off my heel.

At any rate, when we called the surgeon on Saturday night, he said he wanted an MRI. So, the order went in on Monday and the lovely dance with the insurance company starts. The scheduler at the office calls to tell me that insurance denied the MRI and would not give pre-approval for it. Ookay. Apparently it went to them, then to their physician review process, andtheir physician decided that it wasn't necessary and an xray would do.

Um. no. We know I have bones in my foot, but an xray will not show the surgeon if the reconnected tendon is still attached. It won't tell anyone anything except to reconfirm that my foot isn't broken. We know that. So, reconsideration after trying, again, to explain that I'm 10 days post-op and had an accident and stepped on the foot and possibly ripped loose all the tendon attachment points. I talked to them, Mark talked to them, and the scheduler talked to them. Nope! Not medically necessary, an xray shoudl be just fine for diagnosing issues with a sprain/strain.

Wait, what? No, not a strain, you idiots. A post-op accident where I may have torn the freaking tendon loose from the repair. We're trying to determine the patency of the Achilles re-fastening. Back to the drawing board with the insurance company and the medical review group. Seriously, it was like a bad game of Telephone. How the ICD-9 code for 'achilles rupture' became 'strain/sprain' is not quite clear. Well, obviously, the insurance company doesn't want to pay for an MRI if they don't have to. SO they come back with "needs to have a physician evaluation and xray first".

Sure, now I have an appointment for an xray and time for the surgeon to look at me, unwrap my foot, and then note "needs MRI" in the chart. Oh, taht was useful! Dr Leonard dutifully prodded my ankle, noted that the tendon seemed to have the same tension in both heels, and didn't have any obvious injury. And then laughed and said, "But I can't tell anything at all until I see the MRI".

This time, the scheduler called and walked down the hallway with her headphone on to grab the doc when she got the review company on the phone. "Here! I have my physicians, get yours on the phone". It took a total of three minutes for my surgeon to explain just why the other guy was wrong and this was required. Voila, MRI scheduled for that afternoon. Seriously, that was way to complicated for a necessary test (with a pretty hard time limit).

I will say that of course, even if the insurance had denied it yet again, I woudl have had the MRI today. It's not something I"m going to skip just because they want to be pissy. It's necessary and I don't want to repeat this all in six months if we discover that the tendon attached improperly or healed badly.

THe doc said he had a patient last year who did the same thing and never told him. ONce you rupture the tendon, there isn't any actual pain -- like cutting a phone cord: sound one second, then nothing. So the repair shifted, healed badly and too high on the heel and took several hours to fix later on. I really don't want that. I really don't want ANY re-op, and I'm hoping that this doesn't need it. But I am going to do everything to be sure before we write this off as "Robin is a Klutz, please note that in her chart."

The MRI was uneventful. Took longer than I thought it would, with my foot in a very awkward position. You have to be utterly still, so they pretty much strap whichever part of you they need to scan into a brace with foam and velcro.  They have a standard foot/heel brace; nope - can't actually flex my foot far enough to get it into the brace and still scan it all. He tried a round frame that they use for whole foot or knee or hand; nope -- my foot doesn't quite fit without bending it down, can't do that either. It's neutral position or nothing. One last try, a big foam envelope thing that he could pout my foot in  on its side and then fasten it down with another layer and velcro. Felt like putting it in a waffle maker.  The scan of my heel/ankle took about 25 minutes once we got things  velcroed in and me slid halfway into the MRI machine. I had though it was faster, but Mark said that I must have been thinking of the CAT scan machine, which is super fast. This is slow and loud, but turns out pretty 3d images. We notified the radiologist and the surgeon and headed off to  have a burger.

I should hear about the results in the next day or so, and have a default follow up set for next week (it can take 3-5 days to get things read normally, but my surgeon is pretty antsy to figure this out, since if it needs to be re-done, doing it sooner rather than later is a big deal.) If I do need the repair re-done, I assume we'll schedule it for next Tuesday. Oh, fun. Start from square one. I sincerely hope not.

So, think good thoughts that my MRI is clear and that I aggravated this, not damaged it. Every time I slightly twist, or slip and tense my foot, or accidentally touch my foot down, it hurts, so I'm ready for this to be resolved!

Not the worst news

Well,  my wrist isn't broken, or at least nothing obvious is - there are so many little bones taht something could be bashed, but it was proclaimed a significant sprain and they sent me home from the ER with a splint and more pain meds.

It still feels broken, so I apparently did a really good job bashing it when I fell.  My foot still hurts a lot, we're just waiting for the MRI appointment tomorrow to see if I did any real damage. Slept most of the day, after a really awful night.

I am Queen of the Klutzes! All Hail!