(See the update at the end of this post)
Well, it's that time of the year again. The days are getting markedly shorter, the nights markedly cooler, and the weather is taking on its usual autumnal character.
Wednesday was a glorious day. It was warm, sunny and only mildly breezy, following our first overnight kiss of frost. For the first time in more than a month my infected ankle felt good. Not better, but far less painful. I took advantage of that to catch up on a few minor chores. I fixed a bit of fence, replaced a couple of valves on a windmill, and did just a tiny bit of walking -- maybe 500 yards worth. Since I've been laid up I've desperately missed my prairie hiking. It felt good to totter around a bit.
|It's just silly when the calves are this big.|
A fairly fast-moving weather front came through beginning Wednesday evening and clearing out Thursday afternoon. The weather brought about three-tenths of an inch of gentle rain, and the clouds hugged enough warmth that there was no frost or snow. It was wet, but the cows seemed quite content to continue grazing the still-green grass.
Thursday also brought more pain and swelling to my ankle. Did I overdo a bit on Wednesday? Perhaps. Mostly though it's a dammed persistent infection. It's taking more time to heal than I feel is optimal. I'm having a hard time being patient.
Last night the thing "pointed" again for the third or fourth time, forming a bleb of subcutaneous pus. It hurt like the dickens, partly where the egg-sized bleb was and partly from the swelling in the ankle which really seems to bother the lateral ligaments. Each step feels like an ice pick stabbing, which is less than pleasant. Overnight the bleb ruptured and drained, which is all good, but the swelling and infection remain. I'm scheduled to see the doc at noon today so we'll see what we see.
Funny anecdote regarding pus (sorry, you can take the corpsman out of the navy but you can't take the corpsman out of the man); a very long time ago I was changing a dressing on a sailor with some kind of infection. This was at sick call at the Oceana clinic. I was an E-3 as I recall, and wasn't very experienced. Anyway, when charting what I'd done for the sailor I noted that his wound had some purulent discharge, which was the correct medical terminology to use. Only... I couldn't remember how to spell purulent. So I actually wrote, "still shows pussy discharge."
Well, the nurse was not amused. I learned to spell purulent though!
Last evening as the weather system passed the clouds fled, and as soon as the sun fell below the west-southwest horizon the day's warmth fled as well. Overnight the mercury tumbled once again to 31, producing the second kiss of frost but not the hard freeze predicted by the weather guessers.
This morning a spectacularly gorgeous sun lurched over the east-southeast horizon and washed the prairie in brilliant golden light. As solar photons arrived on the scene the light frost fairly leaped from the ground, sublimating directly into a thin mist before wafting gently away on the breeze. Cows and calves were spread out everywhere, heads down for the most part and busily tucking into breakfast.
There's amazing beauty in this place every single day, and I'm blessed to be able to see it first hand. It helps take the grumpy away when I let it.
Update! October 7, 3 p.m. local.
This has been a year for infections on the ol' EJE Ranch. You might recall my posts on the dogs Willie and Red as well as the one on the calf 6042, each of which had abscesses which required incising and draining.
Red's case is, ironically, rather similar to my present pussy (purulent) predicament. As you might recall, she had an infection that wouldn't heal, which almost certainly meant there was something in there that needed to come out. We tried hard to find the object, probing and flushing and even taking x-rays, but when all was said and done we had to open her up to find the culprit. During that entire process I kept thinking, "there has to be something in there, but there can't be, because we've done everything but cut her open and there's just nothing in there."
Now today when I went to the doc she wasn't satisfied with the way things are going and decided to open the area up and look for a foreign object.
All throughout this ordeal I've been thinking back to Red's case, and wondering if there could possibly be some foreign object in my ankle causing the infection. But really, there couldn't be anything in there. Unlike Red I had had no trauma, unless you count the original surgery which was nearly 10 years ago. There's just no way the surgery could be the culprit, because the infection would have shown up years ago. Right?
Luckily for me, Doc Holly is a good deal brighter than I. So out came the knife.
Now back in the day when I was on the handle end of the knife it was notoriously hard to get good anesthesia when working in and around infected tissue. This is because the pH of pus tends to be slightly acidic while the pH of lidocaine is slightly alkaline, therefore pus tends to neutralize lidocaine.
Knowing this, I realized there was an excellent chance that I'd have to endure some pain. My willingness to do so is a crude measure of how very sick and tired I've become of this damme infection. I'm a fairly stoic fellow and can tolerate a good bit of pain, but that doesn't mean I enjoy it. The prospect of being cut on with less than effective anesthesia did not put a smile on my face and a song in my heart. But I was willing.
As it turns out, local anesthesia has improved somewhat since the olden days. The mepivicaine Holly employed didn't numb the tissue completely, but it was far, far more efficacious than I expected.
Anyway, to cut to the chase (sorry), she found a big wad of suture material in there. About five inches of what appeared to be 2-0 or 3-0 vicryl (nylon) suture with several knots in it.
In general, you use absorbable (catgut, chromic, etc.) suture material on the inside. The body naturally absorbs these materials over time, once the tissues have healed. Nylon or other non-absorbable sutures are used when closing the skin, and these you have to clip and remove when the tissues have healed.
Absorbable suture materials are less strong than non-absorbable though, and sometimes you need strong suture on the inside. In those cases you might use stainless steel or titanium wire, clips or staples. You might also use nylon, though that's usually not the best choice because it's not unusual for the immune system to react to and reject nylon.
In the case of orthopedic surgery you obviously need to use pretty strong materials. In my experience and understanding (which is far from encyclopaedic) this is more or less exclusively the realm of stainless and titanium.
That being the case, I was reasonably certain that the surgery had no direct bearing on my present infection.
So, Holly snipped out what she could of the old suture material, but she couldn't get it all. This means I'll be seeing a surgeon next week, and there's a good chance we'll end up doing a surgical debridement.
I'm not looking forward to surgery. On the other hand, I'm very happy that we've found the culprit and that there's likely to be a solid and lasting resolution.
I said I'm happy that "we've" found the culprit, but all I brought to the party was an infected foot. Holly is the hero in this tale.