Wow.

Sorry to have left you all hanging.

I stayed home from the hospital for ALMOST 36 hours.  Almost.

When I was readmitted, my temp had gone from 96.8 when I was discharged to 103.9 when I showed up back in the emergency room.  Seven degrees doesn't matter much in weather but inside a human body, it's a really big deal.  Hot stuff. 

Okay, that was across the lame line.  But it made you either smirk or groan, right?

Reality is, I first mentioned my hand to a nurse at the end of December.  I had the fertility doctor check it on January 5th.

I made my first trip to urgent care on January 12th.  No labs were drawn and the only advice was "use lots of heat.  If it weren't for your leg, I'd say this wasn't infected at all.  But it looks similar to how that did, so I'm going to prescribe this particular antibiotic for you for seven days."  I dutifully soaked my hand many times a day, making sure to move it and use it and get it good and toasty.

Nine days later, on the 21st, I was back in the ER with a temp of 100.9 (normally run 96.5-96.8) and my hand looked... rough.  Bad.  Not so good.  Swollen and red and pretty sore.  I had thought I was getting the flu Wednesday night (24 hours after the last dose of antibiotics), and it proceeded to worsen along with the appearance of my hand.  That doctor said that since the first course of antibiotics worked so well (It did?  Really?  How'd I miss that?) he thought I must be one of those "rare people where seven days isn't long enough" and he was going to prescribe the exact same medicine, at the exact same dose, but this time for ten days.  He said that if the heat helped, I should continue it but it didn't really matter.

My husband and I both felt very uncomfortable with the hasty exam (more just a glance than actual exam), the lack of blood work, and the lack of follow up.  Especially since at that point my hand was acting exactly the same as my leg did last year - and the doctor was acting exactly the same as the doctors did last year.  We kept insisting we were uncomfortable and the doctor got more and more irritated, until he finally offered a referral to the wound clinic.  We knew that the 48 hours until I'd be able to see them (if seen immediately) could see things go south really quickly, but at least we also knew that the wound clinic is home to a bunch of very smart, talented, experienced infectious disease doctors and surgeons.

Wound clinic called Monday morning, offering me an appointment less than 30 minutes later.  It's a 40 minute trip in this weather, minimum.  I asked for a later appointment and was put off until the next afternoon.  That night, I did not sleep.  I used heat, I tried ice, I tried compression, I took Advil, I took Zofran, I took Vicodin 7.5 (two of them).  I finally fell asleep at 7:30 A.M.  I slept until noon, and when I woke up I knew I would be admitted.  For what started out as a simple skin infection of the hand, and even Friday night, could have been handled on an outpatient basis if it had been done correctly.  But now my hand was so swollen that it looked fake.  The skin was shiny and tight and deep, dark red.  It was very hot to touch, and I could no longer move my pinkie, ring, or middle fingers.  The pinkie and outside edge of the ring finger were numb.  And I felt generally sick.  Achy, sweats, chills, fever jumping between 99 and 102.9, unable to keep anything down.  I packed some books and clean underwear and socks and a stocking cap along with my favorite pillow, and off I went to the wound clinic.  My appointment was at 2 PM, my blood was drawn and x-rays taken by 2:30, husband got there at 3:00 just in time to watch the orthopedics consult jab an insanely large, thick needle into my hand in an effort to "aspirate" the pus.  By 4:00 I was getting settled into my room and waiting for IV therapy to come get things started.  After five days of high-dose Rocephin and Vancomyacin, with a Fentanyl PCA pump and frequent IV Zofran, I was sent home with Bactrim, Vicodin, Zofran, and Neurontin for the pain in my now-damaged nerves.  I'd been seen by infectious disease, orthopedics, plain internal medicine, neurology, OT and PT, an intensivist, and about a million interns and 500,000 residents. 

I was thrilled to be going home.  Finally, healing and doing well.

I lasted from Saturday afternoon until Monday morning.

When I was readmitted, my hand was blowing back up, I now had no sensation or reflexes below the wrist in my ulnar nerve and limited sensation and reflexes in the others, and my temperature went from 101 when we left home to 103.9 when the admitting nurse took my temperature. 

More Vancomyacin and Rocephin, more Vicodin ans Neurontin, more days on the Fentanyl PCA pump, More Zofran, more doctors, and an operation to remove the abscessed vein (yes, apparently a not-quite-sterile blood draw can lead to the development of not only phlebitis and cellulitis, but also abscesses inside of your veins) and the necrotic (i.e. dead) tissue that was around it, and I was sent home.  After finding out that the infection I was fighting was directly linked with human saliva.  Eeeeewwww.  There is only one person who could have introduced the germs, and that is the technician who drew my blood in December when all of this started.  I was actually asked this past week, by one of the infectious disease doctors, if this infection was self-inflicted.  Um... no flipping way. Besides, how would I have done it?  "Excuse me, Ms. Lab Tech person, before you stab my hand with that needle, would you mind letting me lick it first?"  Seems unlikely.

Now here I am, halfway through February and two months out from the original offending blood draw, and I am struggling hard to stay out of the hospital.  Three admissions might just send me over the deep end.  Well, not so much the admissions... it's the need for the admissions and the fact that this can all be traced to one person and the fact that we aren't ever going to even be apologized to for any of it, plus the fact that I have long-term, likely permanent, damage and loss of function in a previously healthy hand.

I know, I'll let go of the anger and sadness, and I will learn ways of making my hand do what I need it to do, but right now, tonight, I am so very ticked.

Leg Update.

Have had a few people wondering how my leg is doing... so I thought I'd post an update.  I am 5.5 months post-op, and almost 33% of the way through the "active healing" phase.

The graft is doing well, after I split it open a while back.  Other than the scars from that, it looks pretty good.  It's turning colors, and is closer to the color of my regular skin.  There's something going on with one of the muscles in the front of my shin - it hasn't functioned since I bruised and split things. 

Yes, I bumped the contrast a little on this, so you could see the outlines of the muscles.  See that big gap in my shin?  That's not supposed to be there.

It's hard to sit idly by as adhesions form between the graft and the muscle facia, since I know eventually they'll tear free.  Surgeon sais absolutely no efforts are to be made to stretch or break them until after that 18 months, though, so... I watch.  The medial edge of the graft is adhered to my periosteum.  THAT part of it actually really hurts.  Very sensitive to the touch, very uncomfortable if it gets pulled on.

But over all, I am thrilled with how well it is doing.  It is healing, I have TWO functional legs, I am alive.

And as a friend said the other day... it's starting to look like a leg again.  :)

Stock in 3M

So I've been thinking... maybe my husband and I should support ourselves financially.  By taking out stock in 3M.  You know, the company that makes VetWrap.  I use a roll every day.  For my leg.  Speaking of leg... I think it's time I quit hiding it and post an update.

This is what it looks like all wrapped up the way it's supposed to be.  VetWrap comes in a lot of colors, by the way.  In case you were curious.  I use the VetWrap for the fact that it creates and maintains even tension.

Underneath the VetWrap, I have an ace bandage.  Not a regular one - one that is twice as long as normal.  It holds my foot in alignment, at least most of the time.  It would not be adequate without the VetWrap though.  The tension, if left as you see it below, would migrate and slip, and would fail to control the swelling or assist with circulation.

Underneath all that ace bandage, I have a hefty layer of 6-ply gauze.  I'm not actually oozing or bleeding or anything.  But the gauze is important.  I have learned how to carefully fold it so that it provides padding and also some protection in the instance of shearing pressure over the graft.  Plus, I can gob massive amounts of aquaphor underneath it, and keep everything soft and happy.

The final thing that stands between my leg and the world at large is Aquaphor.  Maybe I should take out stock in Beiersdorf Inc. (the makers of Eucerin and Aquaphor) too.  I use great gobs of it on my graft site every morning and night.  It is, according to the plastic surgeon, the most important thing I can do for the graft.  Keeping it soft helps to gain thickness, prevents it from splitting and causing major issues, and enables it to stretch a little if it is bruised, instead of breaking open.

Okay, this next one is the one that embarrasses me.  Please no mocking.  But also, please don't look away.  I'm not trying to engender sympathy, not trying to say "poor me."  I'm trying to say... be careful.  What you see below is the result of a relatively small self-inflicted cut on my shin.  It got infected.  The bacteria was resistant to treatment and ate away a LOT of flesh, including some important blood vessels and a nerve.  It also inflamed the lining on my tibia, which caused enough internal swelling to significantly damage the interior nerve.  I have no sensation below that ugly hole, short of some intermittent tingling that cannot be interrupted.  Irritating.  But, I am blessed.  The infection nearly took my life.  I am not only alive, but I can walk.  On my own leg.  It looks pretty stupid, but it is attached and mostly functional.  The surgeon was able to move around existing muscles to make up for the loss of one of my shin muscles.  That's why the graft looks so lumpy - the muscles are still settling into their final positions, and are bulking up a little unevenly.  I expect it to improve over time.

Anyway. for the curious, this is an update on how my leg is doing.  I have some big leg-related news pending right now... I will post when the time is right.  Meanwhile, I hope this answered your questions. 

I'm Alive.

It wasn't all that long ago that I wondered how long that would be true. The alive part, that is. I remember the surgeon coming, telling me that the VRE infection I had developed in January was still rampant. It grew both in my wound and blood cultures. For those of you unfamiliar with the abreviation, the VR portion stands for vancomyacin resistant. That means that they literally don't have anything left to treat it with. They were pumping me full of three kinds of antibiotics, plus the antihistamines and steroids required when giving me levaquin (I am allergic). Those would take care of some of the bacteria - the other kinds. But the VRE? The doctor said it was up to my own body.

God was merciful. I initially caught the infection along with four other kinds of bacteria. Most likely from someone who didn't wash his or her hands adequately before applying gloves and doing a dressing change while I was hospitalized. They told me then that there was nothing they could do about the infection. We all thought it had abated, until nearly three months later when my shin literally started rotting off.

God was merciful. In spite of the fact that the original wound was self inflicted, and in spite of the fact that I was falling apart in so very many ways, He saved my leg. And He saved my life.

I was thinking about this tonight in church, and Psalm 143 came to mind. I've got it below for you to read. It just seems... fitting.

O Lord, hear my prayer, listen to my cry for mercy;
in your faithfulness and righteousness come to my relief.
Do not bring your servant (me) into judgment,
for no one living is righteous before You.
The enemey pursues me, he crushes me to the ground;
he makes me dwell in darkness like those long dead.
So my spirit grows faint within me;
my heart within me is dismayed.
I remember the days of long ago;
I meditate on all your works and consider what your hands have done.
I spread out my hands to you;
my soul thirsts for you like a parched land.
Selah. (Which means meditate on this.)
Answer me quickly, O Lord;
my spirit fails.
Do not hide your face from me or I will be like those who go down to the pit.
Let the morning bring me word of your unfailing love,
for I have put my trust in you.
Show me the way I should go,
for to you I lift up my soul.
Rescue me from my enemies, O Lord, for I hid myself in You.
Teach me to do your will, for you are my God;
may your Spirit lead me on level ground.
For your name's sake, O Lord, preserve my life;
in your righteousness, bring me out of trouble.
In your unfailing love, silence my enemies;
destroy all my foes, for I am your servant.

Scheduled Post #1

Today was the Big Day. As written on my pre-op orders, my surgeon performed, on "the lower right extremity," a "deep structure, muscular, and vascular reconstruction followed by a partial-thickness skin graft." I would imagine that right about now, I am in my hospital room either asleep or wishing I was. I'm receiving some pretty heavy duty antibiotics to fight the three bacteria that grew out in very large quantities on the last culture, and have formed obvious colonies in my wound. I've got a couple big whitish-yellow ones, and a couple big greenish ones. Or I should say, I had those. The surgeon removed them.

I can honestly say that while I doubt the next few weeks will be all that enjoyable, I am quite convinced that it is the right decision.

I'm not proud, but the wound was self-inflicted a long time ago. Toward the middle of January, actually. We are now pushing the middle of May. That's five months spent trying to deal with one stupid cut. I'm going to tell you a little bit more about it, just because I want to write it out for my own sake. And maybe some of you will read it and get the guts to stand up for yourself more effectively than I did.

The cut was deep - one of the deeper ones I've ever made. My bone was exposed, a muscle cut through nearly all the way, and an artery severed completely. My husband came home and found me with that and several other cuts, sitting on the floor in a daze. He called 911 - I think I asked him to. I had lost a lot of blood, and was scared. Very scared.

The nearest emergency room happens to be one we don't prefer, but when one calls 911, one loses the option to choose. Fortunately, they allowed me to call my regular physician to come in and do the repairs. He did an excellent job - I was able to walk when he was finished, despite the muscle damage.

I was admitted to the psychiatric unit of a different hospital. While there, nurses changed the dressing on my leg daily. After about a week, I noticed that one cut did not look quite right. I pointed it out to the nurse, and she assured me it looked fine. I know my body pretty well, and knew it didn't look "fine," but I let it go. The next day, it looked even more "off." I pointed it out again, with my husband present. She said that all wounds heal differently and it looked fine to her. The next day, the same thing. 12 days after the original injury, the sutures were removed. The wound looked swollen, was hot, and just a tiny bit pink. But I had no fever and there was no visible pus. I insisted, again with my husband and two nurses present, that it felt very much infected and asked that they please have a physician look at the wound. The nurse practitioner barely pressed on one end and the whole thing split, revealing the infection I had told them was present.

It took a month for the wound to close. Most of that month, I was in the psychiatric unit. I was accused of wound tampering and told that I was the reason for the infection. Cultures grew out bacteria normally found in fecal material, as well as some found in dirt, and some found exclusively in certain species of pet birds. In other words, the infection came from someone who just didn't do a good job of washing his or her hands.

After the scar was fully formed, my leg would frequently swell and get hot just below it. I was assured that that meant nothing. No problem. When yellow fluid began draining from the corner of that scar and from several others, I was told again that it was normal fluid and there was no issue. I let it go. Again.

Nearly a month passed, with constant drainage, swelling, and pain. I was assured by physicians (not mine - he was not yet cleared to see patients following a horrid accident) that it was fine. Told I was being a hypochondriac. My chart was noted that I was suspected to be a Munchhausen's patient. (Munchhausen's is a disease where patients make themselves sick in order to get attention from doctors. For the the record, I loathe having to go to the doctor. For anything.)

I woke up one morning with a leg that was grossly swollen, red, and hot. I had a fever, ached from head to toe, and couldn't stand even the brush of my pant leg against my leg. I emailed my doctor, and waited for the clinic to open. I was given a 2:30 appointment. When we got there, the doctor let us know that a surgeon was on his way over to look at it. Two hours later, I was wheeled into surgery and the abscess was drained. A wide, eye-shaped hole was left that went all the way down to the bone and muscle, to allow all of the "fluid" to drain. Wet-to-dry dressings were applied, that I changed out twice each day. After two weeks of no visible healing happening at all, the surgeon decided he'd order a wound V.A.C. Meanwhile, I noticed that there were little black spots forming inside the wound, around the edges mostly. He assured me that these were just dried spots of blood.

And then the whole thing turned black. As if someone had dumped tar into the wound. And the black started to spread. The surgeon took two days to believe me over the phone, and I came in a day early to get the wound V.A.C. put on. He was shocked to see that it really was black. Rather than do anything, though, he applied the V.A.C. (henceforth referred to as Slurpy) over the top of the eschar. He said he believed it would take care of itself.

Four days later, when I went back in for the dressing change, the necrosis and infection had spread dramatically. Went in the next morning for yet another operation, and stayed in the hospital for 6 days. The day I went home, the doctor applied a special dressing that contained silver. He said that would help kill off any micro-organisms. It started to sting and burn as soon as it was applied, and within two hours, I was in nearly unbearable pain. The doctor did not believe me, said that it was normal for it to burn a little. A nurse brought up Munchhausen's yet again. I asked to either be transferred or released so I could seek a second opinion.

By the next morning when I saw a physician in a wound clinic at a different facility, the reaction between my body and the silver had enlarged the hole in my leg considerably. I was in absolute agony. I was angry, tired, and barely able to think. The dressing was removed, taking with it all of the granulation tissue that had formed during my 6 days in the hospital, as well as the facia over one of my muscles. Fortunately, the exposed nerve stayed intact. The nurse dumped saline into the wound, over and over. Each time, it briefly stung but the agony lessened. By the time she was done, it felt just like it should - sore, a bit of stinging, some aching... nothing even remotely unbearable. The wound doctor looked at the wound and photographed it. Noted that my tibia was exposed. Noted that there were areas of necrosis that went deep into one of the muscles. Noted the exposed nerve. Noted the end of a vein that had been severed by the last surgery. And then referred me to a plastic surgeon.

He took more photographs, looked at the wound more. Talked to me about the fact that he was pretty sure the wound would not heal without significant intervention. Scraped away some colonies of bacteria. Burned away a bit of necrosis. Flushed everything out with saline. Put Slurpy back on, with a normal slurpy sponge. And scheduled today's reconstruction and skin grafts.

The point here? If you know, and I mean absolutely know something is wrong in your body, don't let a doctor or nurse blow it off. I did, and here I sit five months later, waiting to have major surgery and praying that everything can be achieved in one operation. I am on narcotics, and have been for the last three months. I have three types of bacteria that are not antibiotic resistant, and yet continue to colonize the gaping hole in my leg. And if that first nurse, the one who said all wounds heal differently, had listened... well, I wouldn't be in this situation at all. Had it been treated correctly way back in January, all of this would have been avoided.

Speak up folks, and be loud.