Friday, October 14, 2016

MRI Sez...





Osteomyelitis 

And the whackopaedia entry...



Not exactly the "survey sez" clip I wanted, but it'll do.

At this point, about 40 days after onset and no real improvement following antibiotics and several visits to the doc, including the discovery of old suture material left in the joint following my 2007 surgery, that's pretty much what I expected.

It's unlikely that the suture material is the proximate cause here. Most likely it only provided a home for bacterial growth which then spread to the heel bone, perhaps via the titanium screw holding part of the tendon in place. Interestingly, the bacteria probably entered my system from barbed wire scratches I got while working on fence.
Long way from the heelbone...

So. Fairly serious condition which will require IV antibiotics and most likely surgery. I'll be seeing the ortho surgeon on October 27, and we'll work out the surgical plan at that time.

As for the IV antibiotics, the drug of choice is vancomycin, which is a pretty powerful antibiotic which carries a somewhat serious risk of grim side effects, including kidney and liver damage. The risk will be well managed, and it's worth facing considering the potential downside of osteomyelitis (think Gus McCrae after "the injuns shot them arras into him").

In the morning, at 0700, I'll have labs drawn to confirm kidney and liver function and establish baseline values. Assuming my internal organs are up to it (I suspect they are), they'll calculate the dose, start an IV, and infuse the drug over about 4 hours. Then it'll be rinse, lather, repeat every 96 hours for 6-12 weeks.

That's the AB plan as of now.

They'll most likely put in a PIC line next week to make the drug administration easier. That's got it's own potential side effects, but it's probably the best course to take.

I'm going to have to work very hard at being a good patient. I tend to be a terrible patient.

All in all, this isn't something I'm looking forward to, but there are a lot of folks suffering with much more severe problems, and that's the context and perspective I need to keep in mind.

I also need to keep in mind that as recently as 1960 osteomyelitis was considered to be essentially incurable. It's good to live in a time of miracles and wonder.




12 comments:

  1. Replies
    1. Thanks Captain. Looks like a good plan to be executed by good people, and I'm in quite good health and condition, so it should work out pretty well I think. Thanks again.

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  2. I swore when I saw that O word. Please be a good patient, let the Vanc work, and insist on an ID consult once you've got cultures back.

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    Replies
    1. So far so good! Thanks for the thoughts and advice.

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  3. OK, Shaun, you're officially on the prayer list now.

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  4. I will be praying for you, as well.

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    Replies
    1. Thanks Scott! Your Badgic Touch is greatly appreciated.

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  5. Doc,
    This is way radically unexpected. I stay home and get bit by visiting bats and you've got major badness going on. Best wishes, best regards, Be weller.

    Don't all of a sudden drop out of touch. We'll be noticing. Stay with the plan. The plan, as you know, requires breathing, a pulse and some form of humor.

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    Replies
    1. Just slightly less unexpected from where I sit. I appreciate the well wishes a very great deal. I'll add increased devotion to conscientious blogging to my efforts on being a good patient. I suspect that'll be good for me. And I'm an enthusiastic proponent of the plan, believe me! Thanks again.

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  6. Hey Doc, thoughts and prayers headed your way. You remind me of a Master Gunny I once had the pleasure and pain to serve under. He was a veteran of the Frozen Chosin and used every day as a teaching moment whether it was a bad or good day. Appreciate your knowledge that you are sharing with us, just wish it was not so personal. Semper Fi

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  7. Thanks bobbyvee. That is an extraordinarily kind thing to say and very humbling. Very much appreciate the thoughts and prayers.

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