Wednesday, December 14, 2016

An update





I don't know how Sarge does it. He's actually blogged from the hospital a number of times whilst he was engaged in being the main course on the surgical table.

Now when I saw that, I thought, "cool, if I ever fall afoul of the surgeon's knife I'll blog the hell out of it! Show these non-medical types how the surgical blogging is done, I will."

Heh.

As I said, I don't know how Sarge does it. But I do know how I do it -- I don't!

As you may recall, or if you're new here, I developed osteomyelitis (why doesn't blogger know how to spell this simple word, btw?) in my left calcaneus (or this simple word?) back in September. Osteomyelitis is a bone infection, and the calcaneus is the heel bone. Turns out that the infection was most likely caused by common skin bacteria (Staphylococcus aureus) which migrated through my blood stream from superficial barbed wire scratches and took up residence in the detritus left behind following surgery nearly 10 years ago.

That 2007 surgery was to repair the Achilles tendon in my left foot -- to clean up some bone spurs and reattach the tendon to the calcaneus from which it had become partially detached. The surgery and rehab went well, though in the succeeding years I had occasional bouts of tendinitis at the surgery site. As it turns out, these painful bouts may have been more than simple tendinitis.

In reattaching the tendon they implanted a pair of Mitek anchors in the heel bone in order to have something to suture the tendon to, thusly:

Anchors:


All well and good and a miracle of modern medicine this anchor stuff. However, the anchors and suture material are retained in place and can potentially cause some problems down the road.

For one thing, they are foreign objects, and even though they are made of "non-reactive" stainless steel and nylon, the body's immune system will sometimes try to reject them. Immune rejection looks an awful lot like inflammation, and it's now looking like my bouts of tendinitis were actually an ongoing series of rejection attempts. This is not terribly unusual and isn't necessarily a real problem, but it does cause scar tissue to develop, and being mostly avascular (without blood supply, and another word blogger can't spell), scar tissue can become a home for bacteria.

The anchors themselves also provide a potential home for bacteria, and being screwed into the bone, also provide a potential conduit through which bacteria can enter the inside of the bone.

Finally, the suture material left behind also provides refuge for homeless bacteria.

So, in general, the inflammatory rejection response is occasionally painful but mostly benign. So long as there are no bacteria running around loose in the blood stream, looking for a place to squat.

In the decade since the initial surgery, I continued to be a rancher, and I collected hundreds of barbed wire scratches while doing rancher-type stuff. I didn't realize it at the time, but I was taking a gamble with each scratch. Fortunately, my immune system seems to have smashed all the bacteria that invaded my body with each scratch. This is unsurprising, it's what the immune system does. It's what your immune system does whenever bacteria invade your body.

But this time was different. I don't know why, and it doesn't really matter. Somehow enough scratch-bacteria survived my immune system to take up residence in the section eight bacterial housing project in my heel.

Thus began an extended odyssey to treat the infection. Oral antibiotics didn't work, so we got an MRI, which showed osteomyelitis. We switched to IV antibiotics, installed a picc line and continued the IV antibiotics, and scheduled surgery.

Then the surgery was put on hold by bureaucratic fumbling and bumbling. In the mean time, we continued the antibiotics.

Here's an interesting aside. The antibiotic I'm receiving costs the hospital $42 per one-gram dose. That's pretty pricey. But by the time it makes it onto my statement, the hospital charges $587 per dose. The total bill for antibiotics thus far is north of $50,000. I'm not going to expand on the topic here, but it's worth thinking about the how and the why of that price inflation. Clearly it's not just "greedy" pharmaceutical corporations driving up the costs of health care. Let's just say that there are a lot of people "dipping their beaks" in the political-medical complex trough.

Anyway, finally, the surgery was rescheduled for December 9. That surgery took place, and it was successful in removing the anchors and suture material.

Actually had a civilized show-time for the surgery -- 11 a.m. I did the usual check in stuff; signed a bazillion forms and recited my date of birth a bazillion times, had my vital signs taken, then was assigned to a pre-op cubicle in the surgery department. Excitingly, the next thing that happened was a wait of about an hour. I was in...


Finally the nurse came in and told me to change into the backless nightgown. They hooked up an IV to my picc line and trundled me off to anesthesia.

The anesthesiologist was quite interesting. About 15 years old, red hair, coke-bottle glasses, but very pretty and a very nice and engaging personality. She examined me and said she thought we'd go with general anesthesia, unless I had an objection to that. I stated my objection and opined that in my perfect world we'd just do a nerve block.

She really perked up at that. "Oh, I like doing nerve blocks. They have a lot of advantages over general. Let me check with the surgeon and see if he's good with that."

Well, the surgeon wasn't good with that because, depending on what he found when he opened things up, he might need to extend the incision up the back of my leg, and that might go too high for a nerve block.

The anesthesiologist's counter offer was a spinal, and I agreed to that. Putting the spinal in was about like you might expect. I sat up and bared my back, upon which they slathered copious quantities of icy-cold anti-bacterial skin prep. The anesthesiologist then injected local anesthesia and let it do it's magic. She then proceeded to jam a huge needle into my spine, poking around until she found the right spot. This wasn't exactly comfortable, but it wasn't that bad, either. When she'd hit the right spot she squirted in the juice.

My legs immediately began to tingle and feel warm and within about 20 minutes everything from about the belly button down was a dead lump. The surgeon wanted 1:45 of anesthesia so they gave me a two hour dose and I'll be darned if it didn't start to wear off right at two hours, about the time they were wheeling me back out of the OR.

In the OR I was flat on my belly and all the action was taking place six feet behind me, so I don't really have any story to tell there. I never heard an "oh shit!" which I took to be a good sign. I could occasionally feel some needles and pins in what felt like my left foot, and I interpreted this to mean that there was something going on down there. On two occasions I felt a an electrical jolt -- kind of like a shock from an electric fence -- from the same place. None of those sensations hurt in any way, but they did make me a bit anxious. From what I could overhear I had a reasonably good idea of how things were progressing, and after about 1:45 they were finished and a few minutes later they delivered me to recovery.

The spinal experience, I have to say, was freaky as hell. Perfect for pain control but, man, that must be what paralyzed people have to live with. I really wanted it wear off in a hurry. That numb, dead feeling is kind of awful.

One of the really strange things as the spinal was wearing off was that when I tried to move my legs they would move but I didn't have any sensory feedback. This make sense, because with this kind of anesthesia the sensory nerves go first, followed by the motor nerves, and when it wears off the motor returns first, followed by the sensory. It's hard to describe, but I'd lift my leg and watch it come up but it was almost as if it was moving independently and without control. That's the way it seemed anyway. A very strange feeling. Within about 90 minutes of the end of surgery the anesthesia effect was completely gone. That's when I took this picture:


A couple of hours later I was home. They gave me a prescription for pain meds, but when I took it it made me dizzy and sick. Luckily I had some ratty old expired pain pills in the bathroom closet and they worked fine.

I changed the dressing on Sunday. I was supposed to wait until Tuesday but I got it wet showering and figured I was qualified enough to handle the changing on my own. That's when I took this picture:


Yesterday (Tuesday) I followed up with the surgeon. Everything was looking fine and he pulled the drain out. The cultures they took during surgery showed no change in the bacteria so there's no resistance developing. There is and will continue to be a lot of drainage from between the stitches. There's a lot of infection in there and now that the old hardware is gone my immune system will be doing everything it can to "get the bad out." The drainage is kind of gross on the one hand but a good sign on the other hand.

I'm feeling quite a bit better and nearly all the pain is gone. I'll continue the IV antibiotics for another 10 days at least, depending on how the healing progresses. I'll see the surgeon again next Thursday.

Sooo... So far so good!














14 comments:

  1. Well, as I said earlier this week, I'm glad you're on the upswing. Coulda done without the picture of the sutures and drain though! :-0

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    1. Thanks Juvat. Glad you came through your "procedure" okay. Yeah, corpsmen. We've all completely lost sense of what non-medicos find gross. Many times on many mess decks we've driven tough guys away with our shop talk.

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  2. Very glad to hear things are going well. Keep that healing going!

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  3. Glad you didn't hear any "oh shit", my ex was taught the universal phrase "there it is" when she was a med student. Keep posting photos below the fold, I appreciate the gore.

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    1. I actually heard the "oh shit" once when a navy dentist snapped off one of my wisdom teeth. I'll sneak a few more gory ones in. Thanks for stopping by and commenting!

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  4. All excellent news of which I've been staying abreast of over on koobecaF. I don't really mine the "gory" photos. It's kind of fun doing the "don't look, don't look, now I can't stop staring" thing.

    Local anesthetics? Spinals? I'm a wuss, knock me out, I don't want to know what's going on, I want to wake up when it's all said and done. Besides which I come out of anesthesia pretty quickly, though I have been known to surprise the medicos with questions like "Is that clock right?"

    Get well brother.

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    1. The anesthesiologist said that most people want to be put out. I prefer to avoid that when possible, it's skating pretty close to the edge. They're good skaters and all, but still...

      Thanks Sarge. I'm a-tryin' to get more better.

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  5. Glad to hear the surgery went well, and you are on track for healing up! cool photos!

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    1. Thanks Brig. I think it's all gonna work out.

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  6. Glad things are going well. "The Illustrated Man" er, foot. Anyway, good to have you back.

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    1. Thanks Captain! A little graphic, isn't it?

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