The ATR events of this last week had many twists and turns enough to get me spinning!
Can you say pseudomonas aeruginosa? Let’s just hope that this is the closest you’ll ever get to her. My last culture showed that I now have a new bug by this name. I asked my home nurse how bad she was, and all she could deadpan was, “Oh dearie, they’re all bad.” Silly me. Pseudomonas is part of why lesions continue to pop up and burst open.
I’m now at lesion #4, dis-affectionately known as Jezebel. She started out innocently as an itch that turned into a welt, and is now dime-sized and cushiony plump. She’s very unforgiving, very sensitive and within my Band-Aid sticky zone. Peeling off the bandage from her sends me writhing. Though not quite the way I want to “out” myself on this blog, but in hopes of helping someone else with my story, here’s a picture of her.
A detail to celebrate: At least there is a name to what I have so I don’t have to be treated blindly.
No more two-hour intravenous infusions! Pseudomonas and Jezebel concerned my Infection doctor enough to stop my current IV vancomycin treatment for my bone infection and changed it to Cefepime, known within the doc’s antibiotic arsenal to kill pseudomonas. Though still via intravenous drip at 4 a.m. and p.m., it now takes me only a half hour to finish my dose. I’ve fully taken advantage of the snooze bar on my alarm clock to wake me up every 10 minutes to make sure the IV bag does not run dry.
It took me three days of a continuous headache and nausea for my body to adjust to a new antibiotic. All it took to solve this was to heed the common dose direction to “take with food” — I didn’t know that this applied to IV drips as well. So my husband now stirs at 4 a.m. to the crunching of crackers as I begin my infusion.
Unfortunately, this new round of antibiotics extends my IV process another two weeks. Drats, and I thought next week was to be my last.
A detail to celebrate: No more weekly blood tests to gauge the drug levels in my body! Four vials were drawn at each time, and the thought of this cute video was often a great diversion for me.
When the second opinion really makes you think twice. To appease the concerns of those who think that I have been on this journey too long (including me), I sought the referral of an orthopedist from a doctor friend who is the Director of Medical Education at a major hospital in Honolulu. I went to the ankle specialist of a bustling orthopedic clinic where the University of Hawaii athletes go for their sports injuries. She pointed out a major irony as she considered my achilles historical saga.
Apparently, their office refers out their complicated cases to specialists elsewhere on the island. Their foot and ankle specialist was a doctor on the other side of the island who also is a teaching doctor to UH medical interns on their orthopedic rotations — and that doctor happens to be none other than Dr. W — my current ortho. Oh ye of little faith!
Though I was satisfied with Dr. W all along, I needed to put any doubts about my care to rest, and it was answered though this vote of confidence in knowing that I had one of the most qualified doctors. Just like shoe shopping, I always end up buying the first pair I tried on.
A detail to celebrate: I felt the reassurance, even if for a single visit, to have two of my ortho doctors conferring AND concurring with each other as to my next steps — which was to have an MRI done on both my ankle and foot.
The MRI tunnel was as fascinating as a time machine. How they use magnets to the molecules in the body to move in a certain direction so that they can take a grayscale picture of it is miraculous. Though no headphones could mask out the fog horn and railroad sounds, they did offer a choice of music (except for Rap). Ever the one to always pose a challenge, I asked for a National Public Radio podcast. The techie found one for me via satellite about attending one’s high school reunions. It was okay. I should have asked for my first preference: Motown.
After 1 and 1/2 hours in the MRI tunnel (plus another hour in the waiting room), I left at 9:30 p.m. with 40 sheets of MRI images tucked beneath my arm and prayed that they reveal information that would be helpful with my diagnosis.
A detail to celebrate: The validation given by the MRI department saved me $16 in parking (check out this short video link about free parking for some cheer!)
A Fork in the Road: Which Surgical Path Should I Take? After consulting my MRIs and my still-festering wound, my ortho recommended two procedures that both require the S word . . . SURGERY.
- treats the wound only
- a 1/2 hour operation
- general anesthesia
- remove sutures to see if my tendons have reattached themselves strongly enough
- drain out the pus and remove some scar tissue in order to reduce swelling
- opening me on the same incision line increases the likelihood of poor would healing, especially if I need surgery again.
- I’ll be in a cast for at least two weeks, depending on the wound’s progress.
- 1 and 1/2 hour to 2 hour surgery
- My tendon is clipped and the tendon from my big toe is rerouted near the heel with an implant
- I will not have the same dexterity with my foot. (This is a big issue for me, since I DO pick things up with my toes — very convenient for missed shots at the trash can.)
A detail to celebrate: The MRI confirmed that my bone is healthy enough to withstand having an implant drilled into it. (It still sounds painful to me.) The IV vancomycin must have worked!
I choose debridement. Though the doc favored the transfer:
- I want to be 100 percent infection free so that my tendon can recover as much as it can before I consider the tendon transfer.
- The thought of another foreign matter in my body with the implants scare me. My Infection doc said that bacteria likes to stick itself to matter that do not have the ability to defend itself. Given my arduous battle with bacteria, I do not want to open this risk in adding more places for bacteria to hide.
- Having the debridement does not mean that I cannot do the transfer in the future. I’ll cross this bridge when I get there.
I will having my surgery as soon as this Friday, May 22 — my late father’s birthday and one day beyond the 6th month anniversary of my ATR surgery.
My pre-op hospital admission packet is ready and I have 2 days to physically, mentally, emotionally and spiritually prepare myself to again to under the knife and the subsequent weeks of again being in pain and a cast and on crutches. I go somewhat with peace in my heart that this is the right path for me, and that these past months have primed me for this next challenge.
Lastly, I received a delightful gift in the mail today from our blog host, Dennis, with a request that I post a photo wearing it. It’s the achillesblog.com t-shirt and it reads, “Give up? I don’t think so!” What an encouragement for this week! Mahalo (thank you), Dennis!