Week 5 - Stuck in Hospital

Was supposed to be discharged Monday morning. Monday morning came and went. Tuesday morning came and went. Still here.

Living alone in NYC, and in-between apartments when this whole ordeal happened to me, has been incredibly trying.

Let me backtrack. After getting my cast removed on 4/13, we noticed that the incision where stitches were removed had dehisced, and the wound looked possibly infected. Here’s that gross pic:

My OS wasn’t in and a different OS who works with him was there and he prescribed me Silvadene cream and Bactrim pills. The plan was to do that for 5 days and then come in to see my OS.

That Monday, 4/17, I went in and the wound did not look any better. If anything it looked worse. After poking and prodding, my OS noticed pus coming out of the tendon!

I was scheduled immediately for a debridement surgery on 4/19, and to see a Plastic Surgeon (PS) on 4/18.

PS told me to expect a worst case scenario of 3 months to fully heal! 3 freakin months!!

I cried a bit that night, but then picked myself up and said I’d attack this head on. Went in for the debridement surgery the next morning on 4/19.

Surgery was successful. Necrotic and infected tissue was removed. The PS was there to monitor what the OS was doing. Thankfully the initial repair wasn’t compromised, and the OS removed 2 sutures they felt were problematic, but assured me the other sutures were in place and not an issue.

Waking up in the recovery room I realized I was attached to a Wound VAC. Great.

They never told me I would need to stay overnight in the hospital before the surgery, otherwise I would have prepared a bit better. After the surgery the OS’s PAs told me 1 night max, maybe 2, while we wait for wound cultures to come back. That turned into 3-4 days, which then turned into the whole weekend with a monday morning discharge. It’s now Tuesday night, 4/25, and still no plan for how to discharge me.

In the meantime, the Infectious Disease Team has gotten results back from the wound cultures, the sensitivity tests, inflammation tests, and 2 different blood tests - aerobic and anaerobic.

The good: no infection in the bone, blood stream, or anywhere else in body
The bad: Staph infection, sensitive type (vs. resistant)
The game plan: 10 days of IV antibiotics (I believe it is Cefaxone) followed by 2-3 weeks of oral antibiotics. (It sounded overkill to me too, but the IDT say they prefer to be over aggressive and ensure I don’t come back in a month with another infection flare up, which is fine by me).

The wound v.a.c dressing would need to be changed 2x a week by a nurse, and 1x a week by the PS.

My specific issue is that I had to be out of my apartment on 4/12, and wouldn’t get into my new apartment until 5/1. My plan was to stay in an Airbnb to ride out the rest of April, and transition to FWB by month’s end just as I get my new apartment. That plan has gone to complete shit.

The insurance I have is a complete joke, despite the fact that we pay quite a bit for it through our company’s group plan. They refuse to allow me to get the nurse for the IV and the nurse for the dressing change near where my mother lives, and instead want to send me to a Sub-Acute Rehab/Nursing Facility. That wouldn’t be so bad if they had a facility in Manhattan, but it looks like the only 1 facility they worked with no longer works with them.

So 7 days after the debridement surgery, I’m still stuck in the hospital which I’m sure is not cheap for the insurance co. We still have no idea what their plan is for me.

On the bright side, the 2nd dressing change showed a much better (relative) looking wound.

This is what it looked like on 4/21 (2 days after debridement):

It was 3.5cm x 2cm

The next day, on 4/22 the machine was beeping that the seal was maybe loose so a doctor who works with my OS, and happened to be in the hospital, came by to change the dressing. I asked him if I could snap another picture and if he could measure it, since it looked better than the day before.

Here it is:

It measured 3cm x 2cm

Either the wound shrunk 0.5cm between dressing change 1 and 2, or the original measurement wasn’t good. I’m hoping it’s the former. The wound v.a.c. also looks to be sucking up significantly less fluid (blood, drainage, whatever) than it did on the first couple of days, which seems like a good sign. There is also a good amount of granulation tissue starting to form which as I’ve learned in the first step towards wound healing and skin being able to grow.

They also put a PICC line in me yesterday thinking I’d be let out, which was pretty sore for the night, but felt a lot better this morning.

I used to look forward to the end of April when I would be cleared for FWB and off crutches. Now, I’m just looking forward to getting out of this hospital, into a shower, and waiting for this damn wound to heal. Crutches, Wound VAC, and PICC line antibiotics, and potentially a nursing facility are in my immediate future.

Staph Infection - Week 4/5

It is now end of Week 4, entering into Week 5. The 4th week Post-Op is coming up. And I’m writing this from a hospital bed.

When I went in to see my OS after the previous doctor recommended Silvadene and Bactrim for the dehisced wound, I was hoping that nothing new would happen, other than the wound showing signs of healing. It wasn’t.

Instead, the OS and another colleague of his cleaned the area of the wound and poked around, only to find pus coming out of the tendon. They wanted me to see a Plastic Surgeon the next day, with a 2nd surgery in 2 days for debridement.

It hit me like a ton of bricks just how bad this was, and how much more delayed my recovery would be. I was supposed to be PWB this week. I’d be FWB next week. Now I’m dealing with another surgery.

Plastic Surgeon was a Dr. Gloom. He told me matter of fact that this area is problematic and I could be looking at 3 months for the wound to heal, which seemed overly conservative. But with how optimistic every other Doctor had been, I guess it was refreshing to have someone just give it to me straight.

Showed up the next day for the surgery. At this point I feel like a pro. Get into the Mrs. Doubtfire gown, put on the cap. Get the anesthesia, knock out, wake up in recovery room.

Except this time was different. This time I wouldn’t be going home the same day. This time I wouldn’t be sleeping in my bed, and eating my own food. This time I was staying in the hospital.

At first they said one night. That turned into 2 max. That turned into 3-4 nights, which quickly tuned into staying over the weekend.

Wound cultures were down from the incision wound. Blood tests were done, aerobic and anaerobic, and I would need to sit and wait till they figured out exactly what I had and how to treat it.

And that’s just the infection. The wound would be dealt with through a Wound V.A.C. which if you don’t know is a machine hooked up to your wound through a tube that is attached to a black sponge which sits inside the wound and sucks, or “vacuums”, up all the nasty fluid, drainage, pus, and blood from the wound site. Plastic surgeon recommended we start with that, while getting on the appropriate antibiotic to kill the infection, and depending on how well the wound was healing, we’d look at other options to speed up the process including everything from skin graft from hip or calf, pig stem cells, and even shark collagen.

The range of emotions has been intense. When I originally found out I needed surgery again, I cried for an hour straight. This was now seriously starting to get in the way of my life. But then I picked myself up and said the sooner I accept what is, the quicker I can start to attack this.

The lab results came back indicating some positive and some not so positive news. The bad news was that it’s a staph infection. The good news is that none of it spread to the rest of my body, my bloodstream, or the bone. It was localized at the wound site and the tendon. The other good news is that the type of staph is called “sensitive” (vs the other being “resistant”) which means I can take a milder antibiotic which can be administered orally when I get discharged.

That being said, the Infectious Disease Team (I call them my GhostBusters) recommended going home with IV antibiotics for a week or so before switching to oral antibiotics. I’d still be going home with the portable wound vac.

So now I’ve decided to do what I should have done from the beginning, and that is plan to just REST for 3 weeks. No hopping around. No getting my own groceries. No apartment hunting, or hitting the gym. Just freaking rest.

Since I live alone in NYC, I’m trying to see if they can arrange a homecare agency to do the wound vac dressing changes (2 a week) where my mother lives in South Jersey. I’ll need to come to NYC once a week to have the Plastic Surgeon do 1 dressing change per week.

I feel like such an ass for not treating the rest period seriously, but honestly no one knows exactly when it got infected. I’m trying to not dwell on the past at all, and just focus on the present. The present is not much fun to focus on, but it’s what I’ve got. So I’m making the best of the time in the hospital, including catching up on my posts here. Will try to add some of the nasty pics I’ve taken of the wound.

There isn’t a whole bunch of posts on achillesblog.com about staph infections and wound vac (though reading rev246’s blog really gave me hope) so I hope to post here more often and document each step for others. And of course, any words of encouragement are greatly appreciated.

Having recently gone through separation and divorce and exercising and lifting weights all winter, I was really looking forward to moving into a new apartment and starting to date. Now it’s just me and my new friend, the wound vac machine :/

Cast from Hell - Week 4

I was supposed to have my cast on for 14 days. I lasted 10 before I demanded it to be removed.

It was sweaty. It itched like nothing had every itched. The padding inside moved around and caused burning sensations all over my ankle and heel. It was pure hell.

I likely didn’t do myself any favors, thinking that the pain was long gone and I’d be good to hop around town on crutches and cast. I even went to the gym in my building twice to do upper body work.

By the time I went in to have the cast removed, things weren’t looking so hot.

The wound had dehisced. That means it opened up.

It looked downright nasty. It was bloody. The skin around the wound was macerated (that means soft, white, and gooey). The doctor who was there (not my original OS) said it seemed to be just a superficial wound, the top layer of skin, and that nothing serious had happened.

He recommended me to come in to see my OS in 5 days, and in the meantime to apply Silvadene to the area once daily, swap out a gauze pad, and to take Bactrim oral antibiotics just in case. I was switched into my VacoCast boot which I ordered.

This was not a good sign. I was supposed to be heading into Week 5 (4 weeks post-Op) and be PWB. Now I had this new wound to deal with.

The Surgery - Week 1

I never had surgery before in my life.

Maybe that’s why I didn’t stress about it at all. It didn’t bother me for one second that I’d be in an operating room, passed out, while a surgeron is cutting me open. Zero. Fs. Given. I didn’t know what to expect, so I expected nothing.

Got to the facility, changed into the Mrs. Doubtfire outfit. Made a joke about the “cocktail” I’d be receiving to knock me out, and how I like it “on the rocks”. Before I could hear if anyone laughed I was knocked out cold.

Came out in a splint. Doc said everything looked great. I’d be back in 1 week to have the splint removed, stitches/staples taken out, and into a cast for 2 weeks. I wasn’t looking forward to a cast, but it was nice knowing my achilles tendon was finally re-connected and the path towards rehabilitation was beginning.

The Injury - Week 0

March 21, 2017. A day I will always remember.

It was 4 days before my birthday, a Tuesday, and I was supposed to meet a friend after work. We also play basketball in a corporate league on Tuesdays, but I hadn’t played in several weeks as I let a sore knee heal. My co-workers asked me to come to the game, so I brought some basketball clothes just in case I wasn’t going to meet my friend.

Turns out, my friend needed to reschedule. So basketball it was.

I’m not sure if I just didn’t stretch enough before the game. Maybe it was the 3-4 weeks of not playing. I was still lifting at the gym 3-4 times a week, but no running or cardio.

Either way, as soon as I subbed into the game, on roughly the third possession I got deep position in the low post and signaled to our point guard to pass. He instructed me to come to his direction, passed me the ball, and I instantly turned and pivoted hard cutting to the basket. As soon as I pushed off my back foot (right foot), I heard a loud POP.

It felt like someone with heavy Timberland boots stomped on my heel with all their power.

I actually thought someone on the other team tried to harm me purposely. I fell instantly to the ground and grabbed my ankle yelling obscenities. Looking around, there was no one on the other team, or mine for that matter, close enough to me to have hit me.

My teammates helped me up and I knew right away something was wrong. I couldn’t press down with my heel, almost as if there was a bubble of air under my heel that wouldn’t let it step down.

I knew something was wrong and headed to the E.R. And thank god I did.

They did some X-Rays to make sure there were no broken bones, but they confirmed they believed it was a torn achilles and provided me with a plastic splint wrapped in bandages and crutches. Being non-weight bearing immediately was really smart looking back.

Three days later, that Friday, I saw an Orthopedic Surgeon and he told me there was no need for an MRI. This was a complete tear, he’d seen it countless times in his 30 year career, and we would need surgery ASAP. The earliest they could get me in was that upcoming Tuesday.

So as I waited that weekend, my birthday weekend, for the upcoming surgery, I decided that since the tendon was torn anyways I might as well make the best of it and go out with friends for my birthday. Crutches or not, nothing was going to bring me down.