HOBBLING ALONG

It was two years ago, on my birthday that I started having problems with my achilles.  It’s been a long story since, and I realize that this experience has shaped me immensely.  My bruise-scar still makes grown men wince, children question how I hurt myself, and others use my story to justify their inactivity.  It’s a tough injury and life resumes its course soon enough.  I am now training for the Honolulu Marathon after a two-year absence, have SUPped  (Stand Up Paddleboarding), and have climbed many castles in Germany, where I encountered a few VACO-casted tourists who simply nodded when asked, “Achilles?”  It needed no translation.

This injury has bettered me — from being more sensitive and aware of others’ disabilities, to respecting health and the human body’s ability to heal.  In addition, this injury has introduced me to a larger community bonded by our broken tendons.  Our storylines are similar, but I never tire of reading your words.  To help you share further, I’d like to offer one way of posting your photos in your blogs.  This skill and blogging would not have come about for me if it weren’t for my injury and for Dennis giving us this forum.

Happy journeys, all, and I hope to be “seeing” more of you . . .

Booklady’s Steps:

1. Choose your photo from your camera or computer

2.  Google “resize pictures” to use one of the many free online resizing services that will compress your photos to a file size that’s manageable for the web.  (Found this out the hard way after Wordpress kept rejecting my huge files).  I use www.picresize.com because it’s easy and takes about 3 minutes.  On it, put your photo on their site using your BROWSE button.  I click QUICK RESIZE and select my new size to 75% SMALLER.  You may do SPECIAL EFFECTS like FRAMING.  After your photo is resized, save it on to your desktop and rename it with a RESIZED ending (i.e. FootResized)

2.  Login, go to DASHBOARD, POSTS and ADD NEW POST

3.  Enter your heading, write your content

4.  When done, put your cursor at the beginning of your entry.  Hit RETURN key to insert a line space.  Place cursor at the very top of the box (or wherever you want to place your photo within your content)

5.  Click Add Media ICON (looks like a sun) above the format boxes

6.  An ADD MEDIA screen will appear.  Under the FROM COMPUTER tab, click SELECT FILES and locate the resized photo on your desktop using your BROWSE button.

7.  Your photo will appear and you may caption it.

8.  Scroll down further and ALIGN your photo placement (center, left, right), set your SIZE

9.  Click INSERT INTO POST

10.  Go ahead, you can do this!

My son’s college financial aid advisor thought our out-of-pocket expenses for my injury was important information to include on his FAFSA application, so I set out to find out how much my injury cost.

Though I am fortunate enough to have good medical insurance that covered 90 percent of my expenses, the final amount was still jaw- dropping.  My 10 percent co-share was significant to cause a major dent in our family budget.  The final tally does not include Flexible Spending Allowance (FSA) items such as bandages, cast covers and shower chairs, nor does it include mileage for the numerous doctor visits or other inconveniences such as new shoes that don’t chafe at the incision.

My case is a bit unique because I suffered a major infection and had two surgeries:

1. Emergency Room Visit                                                1,574.34
2. First visit to Ortho                                                            329.84
3. Surgery (Ortho, Anesthesiologist, O/R)           10,027.66
4. Ortho casting and office visits                                  1,940.70
5. First round of physical therapy                                  748.70
6. Series of blood work to determine infection          401.50
7. Miscellaneous antibiotic prescriptions                    559.94
8. Office visits to Infectious Disease Specialist          708.96
9. Intravenous Cathether installed                             5,222.04
10. IV Therapy including drugs & a home nurse   20,551.90
11. Weekly lab work to monitor infection                      557.10
12. ID Specialist ongoing office visits                               921.44
13. Second opinion of another ortho                               196.85
14. MRI of ankle and heel                                                  3,983.00
15. Second surgery:  Debridement                             13,048.07
16. Post-Op ortho visit                                                          233.08
17. Final ID Specialist visit                                                   115.18
18. Second round of physical therapy                        1,903.56

TOTAL                                                                                  $52,400.95

10 percent out of pocket                                                       $5,240.00

Being able to walk                                                                         priceless

Hello Everyone!  Yesterday marked the 1-year anniversary of my 2nd achilles surgery, and I thought I would post something to celebrate.  I am glad that my ATR classmates continue to recover, heal and return to their lives.  Thank you Dennis for keeping this site open.  This was truly a Godsend during some dark spots in my journey.

By the looks of the photo above, I do enjoy being able to wear footwear of my choice, and I’m glad wedges are in.  Moreso, however, I am very thankful to able to walk and to resume my physical activities.

During my ATR recovery, I turned a milestone birthday ending in “0″.  My 3 1/2 inch scar still makes others wince, but as I look at photos from a year ago, much progress has happened.

I accept that I’ll never return to where I was at pre-injury.  There is still a bruise.  It takes some warming up in the morning until I loosen up a little.  The first few steps after a start are still gimpy.  I feel a funny-bone sensation on the opposite side of my incision.  The swelling at the end of the day depends on how much salt I’ve consumed and how physical I’ve been.  I sleep with a Phi-Ten brace and it seems to help.

Keeping balance and going down stairs are still issues and I’m not sure they are confidence matters, but I have learned to remember to take slower steps and to pull in my core to be steady.

I’m glad to be able to be normal again.  I’ll never be an ankle model, but I can:

• do jumping jacks and keep up in my turbo kickboxing class
• complete a zumba session without remembering the day I ruptured my achilles in it
• finish a fun run and now begin training for walking the Honoulu Marathon in December
• now fit into many of my closed-heel shoes comfortably, thus satisfying my inner Imelda.

In retrospect, this injury has changed me for the better –  I’m more appreciative of having good health, of being able to move, and being more understanding of those with physical challenges.  Every pain-free step is a reminder of healing, and for this I am thankful.

I hope others on this journey continue with their recoveries as well . . . there really is a light at the end of this tunnel — happy recovery and blessings to all!

Aloha,

Booklady

Whether I count it as my 8th or 2nd month post op progress, the milestones met this July have been tremendous and I feel as if I’ve been given a new lease on life.

Two days after I was disconnected from my PICC line, my tendon celebrated this new phase in recovery by going on an easy-going trip to Alaska and the Pacific Northwest in June.  Though I could pick cherries in the Mount Hood area and do some power shopping in Portland, I still could not climb the 164 steps of the Astoria Column.  I look forward to my next attempt at scenic tower climbing.

At my last follow-up visits a few weeks ago:

• my ortho entered the exam room with his fingers already crossed.  Upon sight of my closing incision, he let out a huge sigh of relief and cheered as if he himself crossed a finish line.
• he gladly signed me back up to see a physical therapist twice a week for the next six weeks
• my Infectious Disease specialist also smiled and proclaimed that this was to be my last visit.  I am glad that brought along a sack of goodies from Trader Joe’s to give to him in appreciation for my care.
• I was able to complete my usual three-mile walk around the neighborhood, though it took an additional 30 minutes
• I resumed my classes at the Y — Butts and Guts, Total Body Conditioning and Core and Cardio Challenge.  Though I do MANY modifications, it feels so good to break out in a hard earned sweat.  I still have to muster up the courage and confidence, though, to return to the Zumba class that I sustained my achilles injury.
• I returned to work three weeks before my official start date (hence, “unpaid” work).  I am on a mission to catch up from the 60+ days of sick leave that I took to tend to my rupture-surgery-infection-infection-infection-surgery.  I am learning to work within my physical limitations:  no pushing fully loaded book carts or carrying 60-pound boxes.

My most strenuous rehab exercise is when I have to stand on a half-round foam balance beam on my weak ankle to do 15 front-side-back kicks with my good foot.  I love the pilates machine and the ultrasound massages with ice packs.  The scar tissue releases felt bad, but were oh so good too.

I still have difficulty with tightness when starting from a stationary position.  There is usually swelling at the end of the day.  Walking barefooted is sometimes painful and though the bruising around my ankle has faded a little, it is still is pronounced.

In all, it has been a good month.  I am very cautious about over extending my ankles.  The number of re-ruptures, and complications coming up on others’ posts on achillesblog are reminders to give myself the full opportunity to recover.

Thank you all for sharing your stories and for being on this journey with me.

I’ve written enough about about my journey on the infection route that I’ve been on since January.  I’ve been sick six of the seven months since my ATR surgery.

I’m at a loss for words.

This is my PICC line, my lifeline to health for 8 weeks — all 45 centimeters of it — that began in my inner arm and ended near my heart.  It needed a strong artery to withstand the drugs, otherwise, I would have had to have a catheter change at least every other day. 

My wound — it’s not pretty, but it gets me there.  I wonder when the discoloration will fade back to my normal skin tone.

My kind doctor reminds me that it has endured a major surgical trauma — twice.

Every day, my ankle reminds me that it is alive.  The prickly pins and needles at bedtime signal strength and healing. 

I could just jump for joy — on the inside for now, anyway!

10 Days Post Op:  Achilles Debridement

After my surgical debridement, I was told to return for a follow-up visit after 10 to 14 days.  We’ve been experiencing some very warm and humid weather lately along with voggy conditions and no tradewinds.  It rained quite a bit on our side of the island it took three days for our laundry to dry in the shade.  (We are still awaiting a part for our dryer repair order.)  If it hadn’t been for the discovery of free internet radio at Pandora, it would have been more miserable.

The 10th day and the first appointment slot at 8:30 a.m. at my ortho’s office could not come any sooner and I spent many claustrophobic nights in my cast counting down the days that the cast was to be removed.

I was so hopeful of this morning’s visit that I snuck the left side of my footwear in my bag, just in case I would be walking out of Dr. W’s office, crutches in hand, walking  full weight bearing, on two shoes, or, rather, flip flops.

I imagined opening the door to his waiting room with the sound of heavenly angels and bright light as the other patients clasped their hands to their chests, waiting for their time with the miracle worker.

Not to be.

But still good . . . the nurse unwrapped my ace bandages and cut the cotton dressings between the plaster strips on my cast.  She cautioned me not to move my ankle because it was now unprotected.  What she didn’t know was that I was already walking on the cast for most of yesterday since I was getting very, very rebellious of using the crutches.

The doc comes in and begins snipping off at least 5 of the 15 stitches on my wound.  He replaces them with steri-strips and puts on the purple scab medicine — just like he did 5 months ago with my first ATR surgery.  He says I was allergic to the inner stitches used on my tendon and the last lesion that was forming away from the incision line was evidence of it.

I asked if he was able to take all the bad stitches out.  He said yes.  (Okay, doc, I’ll call you on this if you didn’t!)

I am worried that he will put me in another cast because the nurse is prepping the water bucket used for soaking the plaster strips.  I am ready to go into my anti-cast negotiation mode of bargaining, promising my firstborn, bribing, or crying — anything NOT to be put into a cast again.  With a sweep of his hand, he halts what the nurse is doing and says to me,

“I won’t put you into cast — you’ll just have to be careful — don’t fall into any holes or do any marathons,” as the sound of angel choirs sing again.

“Thank you, thank you,” I rejoice and I am sent home with my excuse slip to return to work on Friday and a signed application for the renewal of my disabled parking placard for the next four months, ending in October.  (Does he really expect me to be recovered by then?!)

I still have to use my crutches outside the house and I see him again next week to get more stitches out.  I can’t wait.

Notes to Self:  On Taking a Bath

1. Never, ever prematurely throw cast wrappings away thinking that you’re over them.  You had to buy three cast cover packages because you thought you would not use them ever again.  Cost $30.00.
2. Train hubby to leave the shower ready for you.  Tell him it’s difficult to unstack the chairs while standing one-footed on a slippery bath floor, and speaking of shower chairs, be glad you got a real one and not used a flimsy plastic lawn chair.  Think safety.
3. Likewise with the shower head at the lowest position.
4. Keep the soap stocked and fresh towels out so that you don’t have to yell for them.
5. Double-wrapping your PICC line and your casted foot takes longer than the shower itself.  Make it count.  Exfoliate.  Wash your hair often.  Veg with the water off.  Pretend that this is a spa experience.
6. Face the back of the shower stall so that the water streams on you and not on your cast or arm.
7. Keep wrapped foot on smaller stool so that water won’t flow into it.
8. Get everything ready beforehand so that you don’t have to suffer the indignity of streaking across the room in your birthday suit with nothing on but a cast and crutches.
9. If too lazy to wrap, stick broken ankle and arm outside of curtains and shower one-handed, very quickly.
10. Don’t forget to air out your plastic covers.  You now have use of that multi-clothespin ring you got as a white elephant gift.
11. Nudge the cat off the bath rug with your crutch instead of tiptoeing around him.

Friday, May 22, 2009

Post Op Achilles Debridement

6:00 p.m.

My husband recieves a message from my surgeon:

• surgery went well, it took just about an hour
• he’ll see me again in 10 to 14 days
• he washed out my tendon area
• there was no pus
• he removed the non absorbable sutures and then closed me up.

My ankle is in a 3/4 splint — there is a soft spot of padding on my front shin — the rest is in plaster — and am told that I can only put “touch down weight bearing” on it.

7:30 p.m.

I wish I were this cute under the stupor of drugs, but there is a spot on the lawn which marks where I ungraciously “left” the cranberry juice and graham crackers that I was given in the recovery room.  Fortunately, I did this under the cover of night when my husband left me at the car to retrieve my crutches at the front door.

Still being drugged did not help the coordination I needed to walk to the front door on my crutches.  I barely could keep from falling forward and once at the front door, I had my husband wheel me on my office chair to the bed.

I am in intense pain as the anesthetic wears off and against my better judgement, I take a Vicodin to lull me to sleep.

12 hours later, Saturday, May 23, 2009, 8:00 a.m.

I force myself to do an antibiotic infusion.  This is the worst that I have felt in months.  Vicodin and I have a love-hate relationship.  She dulls my pain adequately enough, but trades it for a day-long throb at the base of my neck — either that or the caffeine withdrawals I have been going through since I have decided to stop drinking colas.

How easily I had forgotten the pain of post-surgery — having my body sliced into, flesh excised, tubes unnaturally forced against the tender tissues of my throat, tendon picked at and finally pierced shut to keep me from bleeding over.  The things we go through as ATR sufferers . . .

Hunger is now an afterthought and only exists because I am reminded of it.  My dream post-op meal still remains in the refrigerator and I have to hold everything within me to keep from losing more of my stomach contents.  I guess thick curry gravy over fried shrimp and onions was not the ideal introduction to food.

I break our household rule and have my sushi delivered to my bedside.  I am very careful not to have the little orange roe eggs spill on to the sheets and they pop like little salty pearls in my mouth.  My stomach growls beneath, not expecting to be awakened by such a salty sensation.  The family is gracious to bring me home something to eat after every errand:  acai fruit, brie cheese, bread, crepes, chili, chicken soup, pickled lemons, grated ginger, plates brought home from the potlucks I’ve missed.

It’s only Fresca, crackers and sleep for me.

3:00 p.m., still Saturday

There are no tradewinds this weekend and I feel every toss and turn as my ankle throbs and my torso feels worked out from being on crutches for a total of 10 steps.

I am somewhat hungry and my husband gets a Jamba Juice Chocolate Moo at my request.  He also prepares a just-in-case container for me.  Determined to stay off Vicodin, I down 4 tablets of 200 mg. Ibuprofen like candy.  I prop my foot above the sofa to begin watching our TIVO’d collections of “Law and Order”.  At the second hour, I glance at the nearby container and as if by power of suggestion, the entire moo order comes out in a different format.

The drugs do their wonder and I have the most vivid dreams I’ve had in quite a while — being chased by wolves, squeezed into a dumbwaiter, entering an airplane hangar that looked like a spider and wishing I had a camera to record it — go figure.

Monday, May 25, 2009

8:00 a.m.

I have been afraid to have anything substantial to eat, but this morning, I am feeling human once again.  I am welcomed to this — a “Lover’s Delight” crepe — filled with fresh bananas, strawberries and what seems like a huge glob of nutella.

If I can keep this down, I’ll finally be able to tackle those leftover dream meals that I have waiting for me.

~booklady

Friday, May 22, 2009
Day of Surgery for Achilles Debridement

4:00 a.m.

• my drip times have been running rather sluggishly since Tuesday, when the hospital used my PICC line to inject the contrast solution for my MRI scan.  They told me to flush my line out with Heparain when I reached home.  I think this was too late to avoid any clotting.
• my first saline syringe this morning injected fairly well, but I noticed a strong pressure and resistance when I tried pumping some saline in.
• I remained hooked to the IV for 10 snooze buttons with no progress.  Despite the feeble attempts to clear all tube lines and multiple flushings, I gave up, unhooked myself and went back to sleep.

8:00 a.m.

• I call my home nurse, Mary, to inform her of my unsuccessful drip, and that I am scheduled for surgery at 2 p.m.
• I am hungry, expecting my usual breakfast; my last meal was at 7:30 last night.  Pre-op requires no food after midnight.  I don’t think I can last another 12 hours without food.
• Good news:  the MRI report given to my Infection doctor confirms that I no longer have a bone infection or pseudomonas.  And speaking of pseudomonas, this bacteria must be common enough to be listed on the Costco Disinfecting Wipes container — but still just as devastating to have.

8:20 a.m.

• While showering, I get a call from Mary to report to the hospital ASAP to get my PICC line unclogged.  They are expecting me soon, to get ahead of the deluge of patients anticipated during this three-day Memorial Day weekend.
• So much for my regular grooming routine.  I appear at the hospital with wet hair and I’m half made.

9:20 a.m.

• I am at the hospital admitting office and explain this is my first of two visits today, with my surgery scheduled at 2;  The clerk is very sympathetic as she eyes my PICC line and connects it to my bandaged ankle.  She processes my papers for both procedures and even gives me my hospital bracelet for surgery.  If hospitals have a frequent flyer program, this must be one of the benefits.
• I am still very hungry.  Surely a sip of water won’t hurt, but I have to resist all temptation, lest I jeopardize the cancellation of my surgery due to a desperate measure.

10:20 a.m.

• I was in an exam room for about an hour as the clinic waited for the pharmacy to release the declogging solution.  It finally arrives but the nurse explains that I must wait another 30 minutes after injection to see if it worked.  If it doesn’t, I must be injected again and wait another 30 minutes.  I figure that all this wait time may as well lead into my surgery time.
• Upon doing the preliminary saline flushes before the declogging solution, the nurse tries smaller syringes and finds that they work better.  She attaches a different chamber, goes back to regular syringes, and they work.  My PICC line easily sucks up the saline, and I am free to go.  Crisis solved and it matches the cat. 
• Did I forget to mention that I am super hungry?

11:00 a.m.

• I decide to return home to do an infusion, even if I am six hours late.  It goes smoothly.
• While hooked up, I log in to my work email, and discover the dramas going on at work.  I do what I can from the impotence of my laptop to deal with the hiccups happening on the busiest day of the school year.
• I pray for my work partner, as she does the work of four people, in clearing the entire Senior Class of their book obligations before graduation.
• We will celebrate over a meal of sushi to our hearts’ content when this year is over.  I will miss her as she goes on to her own library.
• I’ve learned, though, that although I have a purposeful career, I still have to take intentional steps to take care of myself and not to rush my recovery.  The beginning of a new school year in July will come soon enough.

11:30 a.m.

• Knowing that I will not be mobile after the operation, I begin to tidy up the house and put away any crutch barriers.  I wash the more-than-usual bath rugs and hang them out to dry on our fence because:

1. our clothes dryer is inoperable, awaiting an electronic part for its repair
2. we used up numerous rugs when the toilet overflowed on Saturday night, when we had over 100 family and friends over for our son’s graduation
3. the other toilets and showers in the house had to be cleaned out with an 80 foot snake on Tuesday
4. Yes, this is an indication of typical life in our household — everything breaks down all at once, ankles included.

• By now, I am famished.

Noon

• My surgeon’s office calls me to come in an hour later at 3 p.m. because he is running behind schedule.
• Does this mean that I have to delay eating also?

12:15 p.m.

• Given this extra time, I decide to go into town to return the decorations that I did not use, while the store refund guarantee was still in effect.
• It was at this generic dollar store that I discovered this:  it is a kiddie inflatable pool with my son, the graduate’s picture on it.  Imagine that . . . there are a million of these pools being sold at flea markets, bazaars, supermarkets, and big box chain stores around the world with my kid’s pic on it.  How random is that?

1:15 p.m.

• Not heeding the advice NOT to food shop on an empty stomach, I braved going to the supermarket to pick up some seltzer water, fruits and cat food.  I did well, with the only splurge being a chocolate mousse yogurt.  I had to think twice on the packaged danishes.
• Despite all the “normal” crises happening today, I finally realized that my foot was not being its painful self.  It felt . . . normal . . .  healed.  You know, like how your hair looks and behaves its best right before a haircut?  I began to question if I needed this surgery after all . . . was there time to cancel . . . do I really want to go through all of this . . . my ortho will kill me if I do.  It only took me limp to remind of the work to be done.

2:15 p.m.

• I am so hungry that I begin to dream of my culinary list of my favorite dishes.  I decide to reward myself with a post-op meal of Tobikko Nigiri Sushi and Tempura Shrimp Curry Donburi bowl from a nearby sushi stand.  I make sure they are labeled with my name on it, lest one of the hungry men in my house gets to the refrigerator before  me.  With all this emphasis on food, do you see where all of this going?

2:30 p.m.

• I take my crutches out of the closet and do a practice run with it to the front door.
• I know that I am in trouble when three steps in, I get a major cramp in my upper abdominals.  Six months ago, at my first ATR surgery, I was in my pre-marathon condition with a core that was awake and the best I had of upper body strength.  I was physcially able to carry myself on crutches.
• I also have to sure that my crutch does not hit the PICC line on my inner arm.
• Six months, lost tone and 10 pounds later . . . this will be a challenge.

2:45 p.m.

• my husband and youngest son take me to the hospital and say a prayer in the car and to kiss me goodbye at the ER waiting room.  I change into my hospital clothes and bag my two slippers as a pair for the last time in a few weeks and I try to blink away the tears.
• The admitting nurse who helped me six months ago recognizes me and remarks that achilles injuries don’t usually last this long.  She goes over my discharge instructions while I am still lucid enough to understand.  She especially cautions on not making any life-altering decisions during the 24 hours after surgery — i.e., not changing my will, getting a divorce . . . etc.
• She gives me three magazines to occupy my wait, and by the time I’m done, I’ve created in my head, the best recipes that I’ve ever read in a while . . . cantaloupe soup, shiitake arborio rice . . . and I put them aside to doze off to the voices of the nursing staff describing their recent restaurant wine pairings and Memorial Day BBQ plans.

4:30 p.m.

• I rouse from my hunger-induced stupor when my surgeon thanks me for waiting for a while.  No problemo, I think to myself . . . I just want this over with so that I can eat.
• He verbally confirms which foot he will work on, and I point to the left ankle which he intimately knows better than I.  He marks it “YES” with a permanent pen.
• My anesthesiologist recognizes me from six months ago as well and remarks that achilles injuries don’t usually last this long.  He reminds me that because I will be operated on face down, to expect swelling after surgery.  I remember this from the last time, and ask him to avoid having my lips bruised and blistered from the tubes inserted down my throat.  Okay, he says.

4:35 p.m.

• My surgical nurse looks over my papers and wheels me to the surgery room.  She too remarks that achilles injuries don’t usually last this long as she tucks my hair into a bonnet.  Don’t I already know it.
• The ER is blaring with bluegrass music, and Frank, another nurse, asks me if I like Toby Raines (?).  Seeing the confused look on my face, he asks me what music I would like.  Recalling my MRI experience, I am quick to request Motown.
• In my last moments, I see the surgical clock set at 0:00 and the other assistants bobbing their heads to Marvin Gaye’s “I Want You.”  Wouldn’t you know . . . just my speed.

~ till my next post, booklady

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.

DEBRIDEMENT

• 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.

TENDON TRANSFER

• 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!

To treat the bone infection that resulted from my wound complications, I started my antibiotic IV treatments on April 15 (U.S. Tax Collection Day for our international bloggers), and it’s hard to believe four weeks have gone by . . . only two more weeks to go, if all goes well.

My two-hour infusions are part of my daily routine at 4 a.m. AND 4 p.m., and I never thought that I could get the procedures down well enough to administer my drugs as if it were second nature.

Meet my PICC line.  It’s a catheter inserted above my inner elbow.  Its dressings are changed every week and sometimes the plastic waterproof tape causes blisters.  The site is painfully swabbed in alcohol at each change.  Think alcohol poured on an open wound.  It’s like that.  I keep it dry to avoid infection at the puncture site.  A foot-long hose dangles from it, and I attach it to another six-foot long tube to connect me to the IV bag.  I’ve given up on covering it with sleeves as our Hawaii winter weather went from the 70s to the summery mid 80s in a matter of days.

I worry about . . .  AIR BUBBLES!!  Since I keep my meds in the refrigerator, champagne bubbles form in the IV bags as it meets up to room temperature.  I have learned how to gently tap the bag to release the bubbles to the top.  I’ve also learned how to flick out the smaller ones that run down the tubing  by “strumming” it to the tune of Don Ho’s “Tiny Bubbles” :)  These bubbles, when collected together, can form an air pocket an inch long — a bit worrisome for me, as the last thing I need as an airhead is a brain embolism.

My nurse friends tell me not to worry, however, because takes an air bubble the length of the six-foot tubing to really cause problems.  The problem is that I’ve slept through several infusions where the chamber has dripped dry and the end of the liquid line was halfway towards my PICC line.  Luckily, I’ve woken up in time to catch this grave mistake.  My guardian angel always works overtime for me.

Here are my tools of the trade.  I have to keep them correctly sequenced, especially at 4 in the morning.  I swab my PICC tubes four times after every syringe injection.  I have to be careful to always flush my line with saline because my Vancomycin cannot be mixed with my last syringe of Heparin.  If they cannot interact with each other in my IV, I really wonder what happens when they mix in my body.

I log my beginning and ending times and remind myself to change my administration tubes every other day to keep things sterile.  I record my reactions and I have found a happy medium in timing my drip speed so that I don’t have to take Benadryl to counteract any reactions.  A smooth, reaction-free drip now takes me at least 2 hours.  Any faster, my heart starts palpitating and a simple brush to the skin is enough to set off a massive hive attack.  It is a battle of will not to scratch.

So . . . has all this hassle made the difference?

Yes:

• because my wound did dry up and the opening did close a little
• the swelling has gone down to the point that my “cankles” (calves + ankles) are not as pronounced
• so that I can say that I did give this treatment a chance to fight off my bone infection

No:

• yet another lesion — my third one — has emerged and popped this weekend
• I’m always in pain — #5 on my threshold level
• I still can’t do a simple supermarket run without being totally exhausted and in extreme pain

This is leading me to believe that though the drugs may be working on the infection, the tendon and my reaction to the sutures continue to cause me problems.  I’ve been on medical leave for the past 4 weeks and just returned to work for one day.  Though I was careful, it was tough.

My last follow-up visit with my orthopedic surgeon had us discussing a tendon transfer as well as a debridement to get the bad tissue out.  It all sounds so invasive, that I’ve made the decision to see another ortho for a second opinion and to see if her plan matches my current doc’s plan of action.

In the meantime, my clothes are fitting more snugly .  The extent of my exercise are pulling my jeans on and doing the contortions needed to compose the photos for this post.  I miss the endorphine rush that helps me feel whole, as if I’m taking care of myself.

It still remains a journey, this detour into the dark valley called infection.  Web research on bone infection gets discouraging as concepts such as “amputation,”  “lifelong antibiotics” and even “death” come up too frequently to be hopeful.

My friends remark how well I seem to be taking these setbacks, and for the most part, I can be postive.  Normally stoic, I am finding that it now doesn’t take much for me to lose my composure.  A call from a special friend, or a sincere, “No.  Really, how ARE you doing emotionally,” are enough to get the tears flowing.

I am thankful that my crutches and boot have served their purposes for now.  I can walk, albeit slowly, and I have adapted to the nuisances and inconveniences of my affliction.  I draw from the reserve of rest gained from limiting my schedule and my medical leave.  I have learned how to receive help openly from my family and friends.  I realize that my condition is now beyond me and anything I can do to control it.  I don’t know what future conversations about my ATR  plans will be like, but I have learned to live these moments in complete surrender to God, knowing that I am “fearfully and wonderfully made.”

I pray for the effectiveness of all this medication and effort, and in the quiet and isolation of my 4 a.m. IV drip, I go before our living room window to wait for the chirp of the first wakeful bird and the promise of dawn that follows it.

A belated Happy Mother’s Day to all the ATR moms out there . . . ~ Booklady