HOBBLING ALONG

I’m usually a go-with-the-flow, easygoing, and low-maintenance type of person.  Down deep inside, however, (at suture level, anyway), I’m just a sensitive princess after all — or that’s what my ankle thinks.

I can now add another medical condition to my achilles saga:  stitch abscess.

It’s when my body tries its darndest to spit out foreign material that normally doesn’t belong there — even when they are the stitches that hold me together.  What results is a very sensitive lump that feels like it is burning, cracking, stinging, itching and ripping all at once, and usually announces itself in unexpected spasms.

I’ve had my share of root canals, spinal taps and childbirth, but THIS pain, though lower-grade in its intensity, is irksome and memorable, especially for a Princess.

This was the cause of the second lesion that formed along my incision line a week ago.  It never broke open before my doctor’s visit four days ago, but instead formed a dime-sized, mean-looking scab.  This was good news because it meant I was responding to the antibiotics and we could delay making a decision on a second surgery to clean up the infection site.

I would post some pictures of it, but the incision in its present state is not a nice introduction of me.

The scab finally loosened and discharged some nice, red fluid — which is progress.  The first hole doesn’t look as deep as before, the swelling and pain have gone down considerably.  I was able to have the past four days feeling a sense of recovery . . .

. . . Until today . . . the throbbing pain has returned enough to wake me at night, and yet another lump is beginning to form, this time an inch away from my incision and towards the back of my ankle — just like her two older sisters.

Although I’m three days away from my next doctor’s visit, I am tempted to call him tomorrow to get on his surgical schedule to get this dealt with.  What we discussed were:

• the surgery will have me completely anesthesized
• he’ll do a power-washing of sorts around the infected area
• he’ll replace the sutures with different material
• my being on antibiotics for this long is of concern

Although I’m a bit more amenable to having this procedure than I was last week (I was in total depression), I still don’t look forward to be put under.  My frustration is that this surgery may as well set me back another one or two months of healing, and that the nice parts of my incision line have closed all for naught, only to be opened again.  I do trust my doc’s care, and since he’s seen firsthand what my tendon looks like, I’m not going to begin second-guessing him now.

Alas, so ends this chapter . . . for now anyway.

Does she live limp-free forever?

Booklady

“. . .  but you may have to have another surgery”  — all because of the dreaded “I” word — INFECTION.

At 13 weeks post surgery, the pea-sized hole in my incision has not progressed at all.  It has harbored a low grade infection that I’ve been trying to fight with 4 weeks of antibiotics.  It took a turn for the worse last week when my stitched area became puffy and so sensitive that a gentle pat with an alcohol pad would have me wincing.

I’ve returned to my boot for the last four days because every step felt like my ankle was ripping apart.  Ironically, it was in using my crutches, I felt free.  I can now understand why people suffering from chronic pain choose to end it all.

Last week’s bacteria culture showed that I needed a stronger antibiotic — this time, Ciprofloxacin — a name that matches its $89.55 price tag.

This morning, another lesion began forming along the incision line and by the time I saw the doctor in the afternoon, it had increased in size, along with its burning pain.  This is how the first wound opening began.  Great — now I have a second one to deal with.

Doc was very apologetic as he squeezed the new lesion to force its discharge out through the older lesion.  It didn’t look like the “healthier” bloody or clear liquid he was hoping for, but rather, it was yellow and thick — not good news.

He dug out some tissue and got to one of the inner stitches that was supposed to be absorbed.  Instead, he found that my body was rejecting the inner sutures, thereby causing the infection.

My tendon recovery has to now take a back seat.

Why the surgery?  To clean up the tissue around the wound and to replace the stitches with suture material that I hopefully won’t reject again.  He may dress my wound with Wound Vac, which is supposed to work wonders.  At least I won’t have to wear a cast because the cut will have to be monitored.

I asked for the weekend to have the antibiotic kick in further and will be seeing doc again on Tuesday morning to make a decision.

Has this happened to anyone else?

Surgery.  Again.  I’m dreading it.  Again.

Booklady

I don’t know about you, but this injury has been a life changer:

• finally, an excuse to start swearing
• taxes will be done on time this year
• a justifiable reason to buy a new purse:  hands-free, leather, exterior pockets, has to be a COACH
• I can finish a crossword puzzle, and the New York Times one, to boot!!
• getting used to sitting while showering
• technophobic moi??!! Designing a blog like this?!  Widgets are now part of my vocabulary.  Bring on Facebook too!
• finding my long-lost writing voice previously relegated to Christmas newsletters and reports at work; now writing with a purpose for a like-minded ATR community (thank you!!)
• unable to carry babies at church, much less pick up the cat
• bringing twice as many shoes on a trip because you only need one side
• literally, economizing your steps, like folding laundry at the dryer, so as not to expend your energy and pain threshold
• this pain is not a sprain and not simply in my brain.  Yeah, it hurts — this is real, people!! (and Vicodin makes me feel like  #@*)
• the kids CAN cook, and takeout is okay
• scanning the cars in disabled stalls for their placards — so much for the $250 fine
• planning for my victory walk on Mount Fuji, Japan in August 2010
• feeling totally useless when it comes to carrying boxes, suitcases, grocery bags, laundry baskets, or dragging trash can to the curb
• having a cane as a wardrobe accessory.  Mine has a dragon with a marble in its mouth and my students often ask if there is a sword in it.  I say yes, just to add to the mystique.
• three months of non-exercise now beginning to show
• casual acquaintances at work now stop me in the hall to ask how I’m doing (I hope it’s the cane and not the weight)
• well-wishers as complete strangers and bloggers telling me to hang in there
• carrying a cloth in my purse to wipe crutches/boot after walking through dew, puddles, droplets
• longingly waiting to walk on sand, gravel, cobblestones, downhill slopes, stairs
• so thankful to have medical leave  . . . and insurance!
• not having to do it all, because, honestly, I can’t — so I don’t . . .
• not having to experience Joni Mitchell’s lyric, “don’t it always seem to go . . . that you’ don’t know what you have till it’s gone . . .” because hubby, kids, friends and colleagues are there, pulling for me — all the way

Just waxing eloquently with you on this journey,

Booklady

So here I am, three months after my surgery, still with a pea-sized open wound that has not progressed much in closing during the past two weeks, despite having been resutured with two stitches.  I still painfully feel every step I walk, and my gait has been described as having a pregnant woman’s waddle or a gangster’s strut, of which I am neither.  If you’re of the same generation as I am and remember the “Keep On Truckin’” cartoon, which has a bell-bottomed character extending his foot in an exaggerated step, that’s me when I walk.

I went back to wearing my boot off and on to lessen my ankle movements, but moreso, to avoid ripping the flesh around my newest stitches that attempted to keep my wound closed — with no luck.  Wearing the boot brought its own evils, as my ankle began to swell and the area circling the incision became sensitive to the touch.  At times it was itchy and I felt the stinging of something being stretched at the back of my heel.  A lump began to form just outside of the incision but it was not a part of it.  I don’t know if the lump was a muscular knot or infection setting in, but leg massages seemed to lessen the pain.

For one day, at the suggestion of a colleague who noticed my discomfort, I used the leaf of the noni plant as a poultice to alleviate the pain.  Like the aloe plant in other settings, the noni is used in the Hawaiian culture for its medicinal purposes and is known to have anti-bacterial and anti-oxidant properties.  Since my wound was sitting in its own sopping gauze and band-aid while being encased in a sock and boot, I was desperate to use any help from Mother Nature.

I wore the leaf during the work day and upon uncovering my ankle, I discovered that the area was moisturized.  I let it air dry and my skin felt its best since my plaster casts were removed.  The pain of the lump somewhat subsided, and I folded the leaf into a strip and reapplied it on to the lump while I kept the wound open to dry overnight.  The next morning a one-inch scab easily peeled itself off from the closed part of my incision.  I was not able to get this same effect, even from the weeks of Vitamin E oil that I religiously applied to the scab every night.

I plan to use the noni leaf again when my wound totally closes and when I’m at the scab care phase, but for now I will concentrate on closing this wound, and closing it well.  Here are a few pics:

Fast forward to this past Thursday at my recent follow-through appointment.  My stitches are removed but the doctor is still dismayed that my wound continues to ooze.  He is very concerned that the area around my ankle has a black and blue bruised look to it, and that there is a dimple where the stitches end and where the swelling begins.  He is concerned that I may have had a low-grade infection despite being on antibiotics, and that the general prognosis is that so many factors are affecting my tendon recovery.  Beginning my physical therapy sessions do not even enter the discussion.

He drew on the exam table’s tissue covering, an example of how thick a tendon should be and it was the width of a finger.  He then drew what he saw when he operated on me, and drew a strip the width of three fingers — and that was my tendon stretched out as result of years of degeneration.  There was so much more weak tendon to repair, and now so much more scar tissue is forming that my skin cannot stretch any further.  How do you fix something that is already so bad?  Am I going to feel this pain forever?  Will I walk normally, or at least waddle-free, ever again?  What will I be willing to live with?

He did discuss an alternative procedure and showed where the poor tendon would be cut out and to use the tendon that connects to my large toe.  When he asked me to move my toe to show where its tendon was, my wound began to ooze profusely, that it changed the course of conversation.  He drained the wound further, took a culture and showed me another way of dressing it.  We’ll probably finish this subject at my next visit next week and discuss its pros and cons.

In the mean time, I am to use the wet to dry dressing method on my wound — to stuff a wad of saline-soaked gauze into my wound, wrap it with more gauze and kling wrap, wait for it to dry, then peel it off, hoping to take some of the dead tissue with it.  It has been drying out, and this is my task for the next week.  Until then, I wait, patiently, knowing that one day this will come to a good end.

On the journey with you — Booklady

I’ve been waiting these past three weeks to begin my physical therapy but can’t until a pea-sized opening in my incision closes.  Has anyone had problems with their wound not closing well?

I had my surgery on November 21, 2008, went through a series of hard casts and finally graduated into a boot with crutches 5 weeks later on December 29, 2009.  About 7 days later, after several lengthy plane rides across the US and while beginning a cruise, a pea-sized spot in my incision began to look infected.  I kept it clean with alcohol and Neosporin.  It seems that the boot irritated my incision.

I got an earlier appointment of 3 days to talk to my ortho about my cut.  He said this was not good news, as I was to have started physical therapy that week.  He took a culture, put the purple scar glue and put me on Clindamycin antibiotic.  He said not to use the boot and to use footwear without backs.  I feel pain with every step.  Walking barefoot is the worst, and wearing my wedges seems to help the most.

A week after, nothing has changed, the culture showed no real infection.  The wound continues to discharge liquid and the Clindamycin gives me great heartburn.  Doc gives me another week to improve.

Another week later on January 29, 2008, I am now 2 weeks behind schedule, and still nothing has changed.  My ortho asks me if I am diabetic (I am not) since I am healing very slowly.  He decides to close the wound with two stitches.  I don’t know what I was not supposed to feel, but I sure felt all four stings of the Lidocane anesthetic (yeah, right) and all four needle passes through my skin and all that tugging to knot the stitches.  So much for feeling like a bee sting.  Doc didn’t even give me a chance to breathe in before he shot me with the Lido.

He put me on another antibiotic — Bactrim, and tells me to go back to wearing my boot so that my foot won’t bend.  If this won’t work, I may have to be re-cast again for three weeks for complete immobilization of my foot (oh no . . . crutches again!).

So far it doesn’t look like it is closing, and I am now at three weeks behind schedule.  Discharge still continues to leak constantly, and it looks even rawer with the stitches.  This is so discouraging, I’m drained by being in pain and discomfort.