HOBBLING ALONG

. . .  my ankle says, “uh, not so fast, there, Booklady.”

I really had thought that this next post was to be my contribution to all the good news of healing that’s going on AchillesBlog.

I too could do my towel toe scrunches, marble pick-ups and windshield wipers easily, and being assigned to only 5 minutes on the recumbent bike barely got me sweating.  After 2 weeks of four physical therapy sessions, I could walk on to a BOSU with my bad ankle, and rocking on the BAP board with 1 pound weights felt good.  My PT file was running out of lines to list the exercises I was doing — after all, it only HAS been four months!  Like a puppy being trained, I was taking it all in except for those 30 challenging calf raises.  My exercise classes at the Y were modified not to stress my ankle, and after several sessions of abs and upper body work, my body felt as if  it were waking up, feeling alive again.

All the while, my PT and I were very cautious and conservative to keep waiting until my then-scabby wound was truly closed and and to be given a final clearance from my Infection Specialist to undergo ultrasound therapy.  I was really looking forward to that two-week follow-up with the ID doc.

Between my Friday and Tuesday PT sessions, however, out of the blue, a discharge oozes out from under my hardened scab, and I pray that it stops there.  It doesn’t, and through the weekend, my ankle swells and turns darker by 10 a.m.  My scar area feels warm and other the sensations from previous infection bouts felt all too familiar.  My last PT session was cut short because my wound truly looked angry and my therapist did not want to aggravate it any further.  Needless to say, I had to make that call suspending future PT appointments until further notice.

That was about a week ago, and it took this much time to scrape myself off the floor to begin to share it and much more to write and reflect about it.  I often cried myself to sleep in the dark these past few days, as I was truly feeling that I was in the shadows of the valley of death.

I returned to my ID doctor in pain, he looked at his pages of notes of my near-weekly visits since February.  He determined that I be scheduled for a bone scan to confirm that my infection had not reached my bone.  I was able to get a hospital radiology appointment on Good Friday and had to go in two phases.

During the morning phase, I was put under an imaging machine which took pictures of my ankles every five seconds for about 15 minutes, and they already revealed the hot spot where my infection was.  I was then injected with a low dose of radioactive isotope and instructed to return in three hours when my bones would glow under imaging.  And glow I did.  My hot spot showed brighter and it was very close to my bone.  The radiologist had me linger a few more minutes to take additional x-rays of my ankle to confirm his suspicions.

Though it was a great Easter weekend, it was a long wait to call my ID doctor on Monday, and when I did, his nurse told me to come in immediately.  In my gut, this was not to be good news.

I was his first appointment the next morning when he told me I had early stages of osteomyletis and confirmed I had a bone infection resulting from my lengthly wound infection.  Sigh . . . my mother’s and other caring ones’ warnings to ”take care that your infection does not reach your bone” reverberated in me, as I was indeed not well, literally, to the bone.

Doc told me the antibiotic therapy for bone infections was intensive and was not to be any different for me.  I started these processes this same day.

• I have a foot-long PICC line (a fancy intravenous tube) coming out of my left arm.  It was inserted under hospital conditions by a radiologist and his team of nurses.  It follows one of the major veins up my arm and leads to my heart.  It was amazing to watch the live x-rays of it being done.  I saw my ribs and my heart beating in real time (I do have a heart after all!  God, please protect my little heart!).   The tubing looked like a parabola or the St. Louis Arch in me.
• Rather than being admitted into a hospital, I was assigned a home nurse who walked me through my intravenous process.  Her handout listed the 21 steps I needed to do at each dose administration, which will be exactly every 12 hours, twice a day, for the next 6 weeks (or 8 weeks, if my bones are not cooperative).
• My home nurse brought her pharmacy with her.  I have syringes of saline and  heparin, boxes of tubes and  alcohol swabs, bags of Vancomycin antibiotic in my refrigerator and sterile syringe caps.  I have learned how to disinfect my work area.  My day now revolves around these doses, or infusions, as they require about 2 hours of drip time.
• She’ll be visiting me weekly to draw blood samples to make sure my kidneys are functioning well, to change my PICC line and to deliver supplies.

So as not to bore you with the mundane details, I’ve learned to make light of the observations I found in this process:

• Although my infusions are supposed to take 90 minutes at 10 drips per 10 seconds, my first one took 4 hours because I had an allergic reaction to the Vancomycin.  I felt a huge hive attack coming on, with severe itching on my scalp, face, chest and  joints.  I had the red (wo)man’s syndrome and learned what a real hot flash felt like.  I had to reduce the drip rate to 1 drip every 3 seconds.  My nurse had to observe me for our full consultation and did not leave until 8 p.m. that evening.  She must have been climbing the walls.  Sorry!
• To counteract the Vancomycin reaction, I have to take 2 doses of Benadryl 30 minutes before each infusion.  The irony is that I have to wake up at 3:30 a.m. to take the Benadryl which makes me feel loopy for the next 12 hours.  Yes, I’m not good for much anything at work and home.    Driving under this influence is not advisable.  I’m trying to wean myself off these bennies but paying for it with longer infusion times until my body gets more adjusted.
• The doc says that there is another drug available if I’m unable to adapt, but because bone infections are treated “blindly”, Vancomycin treats a wider range of bacteria than the other drug.  The other drug also requires thrice-daily infusions and very frequent diarrhea attacks.  I think the vanco will be my drug of choice.
• By the end of the treatment, I will have had 84 infusions and 168 hours of drip time, not including loopy time.  This is more than a part-time job!
• Though it’s tempting to sleep through the infusion, I have to be lucid at the last drop because if I allow the IV bag to drip until dry, the pressure will then cause my blood to be drawn into it, and I don’t intend on being a blood donor at this time.

The photo above is of me and is my newest dance partner.  I haven’t named him yet.  We’re quite clumsy together at our 4:oo a.m. AND p.m. dance sessions.  We keep waltzing into door posts, ceiling fans and light fixtures.  Though the tall and slender type, I’m finding out he’s quite a drip and a drug user; it would be great if he had wheels.   I’m already trying to nicely figure out how to pass the time away on this lengthy, obligatory blind “date” — maybe over a jigsaw puzzle, beginning to watch LOST from Season One or Korean soap operas, scrapbooking, reading with my feet up, Face Booking, blogging, meditating or learning Italian, perhaps?

These are the things I know:

• My hubby’s quite the ham when he asks me, “did I shoot anything up yet?”
• The medical field truly produces a lot of plastic waste, which I have to learn how to properly dispose of.
• I’m so thankful for my hospital chaplain friend who walked to the doctor’s office to be with me when I received my bone’s prognosis.  My hubby was out of town on business and visiting our oldest son.
• My friends who have known of my achilles journey shake their heads in disbelief when they see the newest bandage on my left arm and ask, “What now?”  What they don’t know is that I wrap BOTH my left foot and my left arm with plastic at each shower.  Put together with a shower cap, I become Plastic Lady.  I’m quite a sorry sight to see
• When all this is over, I definitely will get over my fear of water and learn how to stand-up paddle board.
• My appointment with my ortho this week will be interesting, as I had my radiology report sent to him too.  I’m really one for his case studies.
• I’m taking the next two weeks as medical leave — three, if need be — thanks to my work partner who holds the fort so well, especially at this time of the school year.  I am not allowed to lift any weight, including textbooks, on my PICC arm.  I guess carrying books are now a workplace hazard for me.  I did bring home work that I can do on-line.
• I’m still thankful for good medical insurance that keeps me in good care, though this round will require a $200 out of pocket co-payment per week (there goes the tax refund).
• I barely could keep it in when my ID doc told me he was praying for me, as is for those closest to me.  I’m receiving it intravenously and divine interventionally.

Cheers, Aloha and God bless until my next post; you know where I’ll be at every 4:oo hour –

Booklady

I’ve never received a more welcomed prescription than the one my orthopedic surgeon wrote for me earlier this week — one that assigns me to a Physical Therapist for 2 times a week for the next four weeks.  The wound has been looking its best in months, and I will not have to undergo another surgical procedure to clean it up.   I’ve been seeing my ortho every week since January and will visit again in four weeks.

Doubling the joy is that my Infection Specialist has taken me off the antibiotics, since my wounds are drying up, my kidneys are fine and my bacteria cultures are returning sterile, which all means I am now infection free.  I also managed to lose 10 pounds because of the water pills that control the swelling.  It may because of the flu that I had, but I’ll take any weight loss what ever way I can.  I’ve been seeing this doctor every week since the end of February, and my visits are now bi-weekly.

Thank God for good medical insurance.

I am happy because the event above should have come in January, as I am now four long months post ATR surgery and only now starting PT.  It was very discouraging to see my fellow recoverers sprint past me while I was sidelined, but I remain hopeful that I can join the race again.

Of course, I booked the first available PT appointment and met with my PT Assistant who among other things:

• measured my ankle movement every which way
• with my eyes closed, had my good foot mirror my injured foot’s movements to gauge my nerve perceptions
• tested my toe curling and foot pushing strengths
• tested my ability to do a calf raise, which I cannot do, mainly because of lack of confidence and fear — not even one!!
• assured me that my achilles has reattached.

My physical program for the next few days until my next session on Friday:

• Ankle ABCs twice a day
• Stretch Gastroc uni standing, 1 set of 2 30-second reps
• Calf Raises with the accommodation of  raising with both feet then lowering with left foot slowly, 1 set of 10 reps twice a day
• Stand on a pillow or mini-trampoline on my left leg and balance for 30 seconds at a time

My last news is that I’ve been given the clearance to reinstate my gym membership, though with the caveats of going easy on anything that would stress my ankle — no jumping, no pliometrics, no steps, etc., which is all good by me.  Of course, I zipped to the membership counter to redo my paperwork and bumped into a few gym classmates.

Given so much good news these past few days, I did what anyone on Spring Break does — to celebrate happily.  My choice today was to have a Chinese Food luncheon with my mother.

Wishing everyone well –

Booklady

Kailua, Hawaii

. . . as in Infectious Disease (I.D.) Specialist.

At first, Dr. Ortho was pleased.  The first hole in my incision line, who I’ll name Sister #1, the one that has plagued my life by:

1. not closing since November 2008,
2. forcing me on 3 rounds of 3 different antibiotics for the past 6 weeks,
3. holding up any introduction to any physical therapy since January, and
4. having me consider another surgery just to clean it up . . .

. . . has finally formed a nice scab!  Yay!

His examination, however, of Sister #2, who was just a little scab last week, will continue to plague my life even further.  She is:

1. now an opening the size of a thumbnail,
2. an angry red,
3. weepy,
4. another example of the stitch abscess and pseudomona that has formed on my incision line,
5. as painful as heck,
6. another confirmation that I may be reacting to my stitches, and
7. the reason to bring on Dr. PN, one of the best Infectious Disease (I.D.) Specialists in the state.

The clean-up surgical procedure entertained with Sister #1 is not an immediate option at this point, as Sister #2’s wound size cannot be stitched closed.  Foremost is to have this infection controlled, so sorry achilles, we can’t get to you just yet.

Dr. PN, a wise old-school sage with a pragmatic approach has me on:

• Amoxicillin to fight the bacterial strain I have,
• Furosimide water pills to reduce my swelling,
• Potassium Chloride to replenish my low potassium levels important for tissue recovery, but especially to offset the effects of the water pills, (ah, the world of drugs),
• a directive to keep my ankle elevated above my heart, even at work, and
• an appointment in 5 days to see if my body responds

According to Dr. Ortho, we’ll decide next Monday if I may still have to have the clean-up surgery and to be put on a Wound Vac.  It’s really a wonderful thing:

• It vacuum seals the wound and encourages tissue growth,
• It is administered in clinical settings to ensure sterility,
• It’s smaller than a cooler,
• I’m attached to this vacuum 24/7,
• I have to be hospitalized . . . for the full-blown surgery . . . AND . . . for the vacuum treatment . . . for two weeks . . . AND/SO
• It will give me more to blog about.

One more thing . . . I’ll introduce you to Sister #3 as she makes her grander entrance.  Sigh.

I’m never the textbook case,

Booklady

Between the Seventh and Eighth Mile on the Honolulu Marathon Route

Seven point two miles. That’s what the widget on my home page’s ATR Recovery as a New York Marathon said on March 1, 2009. It’s where I would be on a 26.2 mile marathon course.

I am a walker but because of my injury, I missed the December 2008 Honolulu Marathon that would have been my 5^th consecutive race.

How I missed eavesdropping on the side conversations between racers. How I missed acknowledging the overly enthusiastic shouts of the Japanese tourists’ “Ganbarree!!!!” (“go for iiiiit!!!”). How I missed partaking of childrens’ cereal offerings on the residential parts of the course. How I missed digging out the water cup pulp lodged in the grooves of my shoes. How I missed the silencing of conversation during the last five miles and the random musings that kept my pain at bay to carry me through the lonely stretches of highway.

I informally begin training for the marathon in February with an 8.15 mile family-friendly walk from the Aloha Tower to the Aloha Stadium on Oahu. I incorporate 3.5 mile walks several times during the week and do my practice racecourse walks around Labor Day. It’s not really training , but more of a life habit of walking and loving it.

Since the metaphoric 7^th mile of my ATR recovery was coming, I made it a point to make a pilgrimage this weekend to my most poignant part of the Honolulu Marathon course. It may not seem familiar, but it is, for this is at the bottom slope of Diamond Head, the iconic geographic symbol of Hawaii.

By this point on the course, the race began 7 miles ago in Downtown Honolulu with 5:30 a.m. fireworks and the boom of the starting cannon, much to the chagrin of the luxury oceanfront condo owners in their beds who wonder why they too must become part of this contest. The race has thus far taken me past Honolulu’s Chinatown, the business district and city municipal buildings with its lit-up holiday decor, the palace and statue of Historic Honolulu, a sleepy Waikiki Strip and the dawn’s light as it breaks off Waikiki Beach.

By this time I have secretly chosen the walkers with whom I have kept pace and started imaginary mini-races with these unknowing competitors and enter them into a personal race with me. The 70-year old Japanese tourist woman in front of me especially seems daunting. I realize that she may be actually 80 since Asians look younger than they are. In my mind, I lasso a rope around her waist and she pulls me along with her strides until I meet up with her. Winner! My next target this time is a silver-haired man in his purple-shirted Leukemia and Lymphoma Society shirt. I repeat my lasso trick. Winner . . . again!

There’s a reason why race statistics have age divisions, and I would share top rankings too — if I were in divisions 20 years more than my actual age. Perhaps I should choose targets who are closer in age to me. Drats, I cannot pass the sculpted lady in the Lululemon yoga pants. Let’s hope she goes for a bathroom break at the next station. I meet my fair match with a man in street shorts, faded t-shirt and woven lifeguard’s hat. They don’t call this marathon “the people’s race” for nothing.

The rush of the chocolate energy gel taken several hours ago is wearing out. I rue the decision to bring my iPod, my keys, extra band-aids, my Chapstick, a mushy banana, too much trail mix, another energy bar, one pack too many of a just-in-case gel, and a dollar bill and Tylenol, as if it mattered. If feel every ounce up the 100 feet above sea level ascent of Diamond Head. The morning sun looks like the gold of the afternoon, and the salted humidity of the ocean water from the cliffs below mixes with my sweaty glistening.

It is here that I seriously contemplate giving myself permission to end this race, for there is already the been-there-done-that of last year’s completion and next year’s contest to put on my to-do list. The physical discomforts of this race begin to make their presence known, and I know there will be more. I feel my bandaged toes through the dampness of my socks. I worry about blisters. There is a slight pain in my heel. I debate whether to take advantage of the next station.

At mile 7 I begin to feel the doubts of why I entered the race. I have been too selfish with my time? Am I doing this for the recognition? Have I trained enough? Do I have what it takes? Why put myself through this pain? Why do I have the audacity to think that I could even finish this?  What am I trying to prove?

Then something beautiful happens at mile 7.

The race masses’ Sisyphus-like trudge up Diamond Head is stirred by the din of motorcycles purring. Human voices awake and undulate louder as if a volume knob is turned. A huge wave comes, and it comes towards me. It breaks at my feet, and I see it is the lonely, singular intent of the first place runner. For one step, we face each other, and I see in his eyes the focus, determination, willingness and gratefulness for the act of running. His every tendon, sinew and labored breath has led to this pointed victory.

I am happy and I cry, for we are in the same race, this world class runner, and I –the morning walker — and every racer in between, whose reasons for entering this race are as varied as the ocean waves. For one moment there, we all share one thing – a personal victory gotten from the same race run together.  It is this picture, captured long before tomorrow’s morning paper, that lifts me to the final .2 mile finishing chute.

Today, my marathon is a different race, but yet it is similar. I too share in the race of the ATR runners who I am meeting along the way. I lasso myself to their experiences, pulling myself up with them, and allow myself to fall behind and to rest along the way as I journey the remaining 19 miles of my race.

I cry with them at every crutch slip-up and laugh with them on their adjustments to the unwieldiness of our casts and boots. I too share in the doubts, fears and frustrations of recoveries that do not follow the textbook sequences, and I too wish I were further along in the race. I happily revel in the victories of those approaching their normal gaits, and I realize that our race recoveries are as varied as the stars. Though we share this affliction called Achilles tendon rupture, we will be connected by our journeys as we approach our personal finish lines, one-by-one, step by step.

Aloha,

Booklady

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.

I had my surgery the week before Thanksgiving on November 21, 2008 and was put into a removable boot on December 29.  During surgery, my doctor said that my tendon quality was very poor and that they were three times as inflamed as normal.  He was not overly optimistic that my recovery would be a smooth one and introduced the possibility that I was at greater risk for a re-rupture.  What else could I do but to hope and to go with the flow?

Instead of hosting a Thanksgiving luncheon for 50, we had others preparing our turkey for us instead.  The holidays were a wash and the extent of my festive holiday spirit was limited to getting a pedicure with some flowery nail art since everyone was going to be looking at my foot anyway.  This was pretty depressing for a person who regularly DOES deck the halls with garlands at every window, who has at least 2 fully decorated trees and numerous creche scenes placed on every household surface.  Gone was the seasonal gift wrapper position at a high-end culinary store, not only for its generous employee purchase discounts, but more for the sheer joy of professional-standard gift-wrapping itself.  Gone was the chance at a fifth Honolulu Marathon with the aim of shaving 15 minutes off my last year’s time, and it was truly a sad day when I had to suspend my YMCA membership.

Getting out of the cast, therefore, was a welcomed relief — no more plastic wrappings before bathing and I was more than ready to ditch those crutches.  The incision was healing nicely and I spent a half hour in the shower exfoliating and making my leg look presentable again.  My incision was drying up nicely except for the one spot that continued to drain even when I was in my hard casts.  It was a step towards normalcy (no pun intended) — or so I thought.

It was a major milestone to be promoted to a boot, especially since we were flying out on New Year’s Day to Florida to go on an Eastern Caribbean cruise.  (Yes, it’s kind of redundant for a Hawaii resident to vacation in the Caribbean, but it was for the in-laws who live in Florida).  Nonetheless, it was a chance to enjoy not having to do housework on crutches, and I was ready to leave 2008 behind.  My doctor was concerned about the long flights over the Pacific AND US mainland (plus a 6 hour layover in Los Angeles preceding a red-eye) and the swelling and pain associated with it.  I was to continue using my crutches and to begin putting some weight on my foot, though I was advised to also listen to my body.

I used my crutches with my boot at the airports and limited my wheelchair requests, since the airlines were selective as to where they could/could not take me.  Long story short, an airline has to “sponsor” your wheelchair use from one destination to another, i.e., you cannot go to the International terminal to dine there and return to a domestic gate unless you are traveling with an international airline.  Fortunately, an airport employee recognized my plight and taught me what to say (as in “fib”) so that I would not have to take a string of shuttles to get back to my connecting airlines on my crutches.  Had I known that some mediocre sushi costed $14, I would have settled for a simple Starbucks scone at the United terminal.

I took Aleve and removed the boot when I could during the flights.  We left our home at 4:00 a.m. on New Year’s morning and finally entered our ship staterooms at 1 p.m. on January 2.  My stitches were still looking okay, but my foot was very swollen because of all the walking and airplane pressure.  It was indeed a long journey, and we looked forward to our first day completely at sea, with no port stops, to catch our bodies up to six time zones.  I dared not to put any pressure on my boot and kept with the crutches.

On January 4, at our first port stop, I noticed my incision area becoming irritated because of the extra sponge inserts’ snug fit.  I put some Neosporin on it and occasionally cleaned it with some alcohol.  I was getting concerned because the next few days were the most grueling of the cruise, since we had excursions planned in Puerto Rico and St. Thomas.  At those ports, I walked with my crutches and boot, still not putting any weight.  It seemed that the incision condition began to worsen with each use of the boot but improved whenever I took it off.  A pea-sized opening had begun to open along my incision line and started to ooze some clear discharge.  I was hesitant to go to the ship doctor, since there was an outbreak of the Norwalk virus onboard.  I took out the foam inserts that cushioned my heel.

My incision area would periodically get itchy when my foot was swollen, and I finished the cruise with my pattern of keeping the opening clean and drained.  I tried to stay out of the boot, “kneeing” my way around our room on cushions, sofas, bed, etc.  Down deep inside, I knew I had to see my regular doctor earlier than the Thursday appointment I had on my return home.  On the flight home, I had to use the bathroom but could not access my crutches since the flight attendant stored it somewhere else.  Walking crab-like down the aisle and using the seats to brace me, I had no choice but to walk with my boot on.  My first few steps felt as if I were walking on needles, but it was bearable.  The following day,at home, after finding footwear that did not make me walk very lopsided, I tried walking more with just the boot, and spent most of the day’s tasks in it except for shopping at Costco, where I used the electric cart.

I did get an earlier appointment in the week, and I learned I was to have started my rehab exercises during this visit.  On seeing my open incision, however, the doctor was very concerned and considered it a setback, as he was unsure of how the tendon was healing since the outer skin was not.  He said I could not begin exercising until the incision was closed.  He put a purple glue on it, which was supposed to encourage scab growth and also took a culture so make sure it was not infected.  He put me on Clindamycin antibiotic and told me not to wear my boot because it was irritating my incision.  When asked if I were to use my crutches alone, he said not to use them because I needed to begin using my foot.  Oh boy . . .

Though the first steps were difficult, it has been five days since.  I am now walking with a pronounced limp, and the outer side of my foot feels more pressure than the inside, where my arch is.  Walking flat-footed, or with slippers is painful.  I’ve discovered that using a sandal with a slight lift alleviates the soreness.  I’m still trying to figure out how to walk with less heel pain, and a cane seems to help, though I get tired on my feet very quickly.

My next visit is in four days, and I hope that my incision gets better.  It has been discharging less and it seems that the hole is shrinking, but I notice that it gets irritated at the end of the days that I have walked a lot.

I realize that I have been at this only 2 months out of 12.  It will still be a long journey ahead, but I’m hopeful because of the experiences shared on this blog.

Thanks to all who have shared.