Wednesday, May 29, 2013

Bunion Surgery and Surgical-Site Infection: Aftermath



This recent bunion surgery and reconstructive surgeries educated me in the miracles of modern medicine--what a great time to be alive.  American health care gets a bad rap at times, but I wouldn't want to live at another time or in another place.  And medical insurance.  I feel for those who don't have access to it.  It has brought great peace knowing that whatever needed to be done to fix my problem, could be done, because insurance would provide.  I'm grateful for priesthood blessings that promised me healing and peace.  And for all the kind and helpful people who stepped up during this crisis--visiting teachers, ward members, family members, neighbors.  Just one example of going above and beyond is my 90-year-old friend A, who carried a pot of delicious homemade soup up my 8 front steps and into my house, then came back the next day to fetch the pot, and brought a plate of treats.  Emily was there when I needed her.   Craig took over all my home duties, my care, drove me to just about every appointment, hung out at the hospital with me, cooked, shopped, cleaned, etc. etc.  Thanks to everyone.  I strive to be like all of you.




The Wound Clinic, or, "Where the Angels Work"

Who knew there is a such a place as a wound clinic?   For a month I was treated here 2x per week.   The staff here was so concerned and friendly.   C was my specially trained nurse and expert in wound care.  On every visit though, the other staff would at the very least, open the door to my room to say hi, how ya doin'.  They often came in to look at the progress of my wound, and even though it might look ghastly to a non-medical person, they always marveled and exclaimed at how much progress in healing had occurred since the previous visit.  S always photographed my foot to chart the progress.  They were all upbeat and kind.

One day while I was being treated I heard a bell ring--a hand-held dinner bell type of sound--and the nurse excused herself for a minute.  She later told me that the bell signified that a long-time patient was on his/her last visit, and was "graduating."  The whole staff assembled to say good bye and wish them well.  You can imagine the horrendous wounds (burns especially) the staff treats, and patients become part of the "family" there.

One day I showed up (no appointment) just to slip in to pick up a pressure sock, and the nurses decided they should look at my wound as long as I was there.  They accommodated me in a room and located the doc so he too could take a look too.  I think this place works like the parable of the loaves and fishes.  There's always enough people, enough time, enough rooms, to take care of the wounded; they expand to meet the needs of the patients.

C is a proficient, kind and compassionate care-giver.  My foot and leg were bandaged up to the knee, so I couldn't ever shave that prickly leg.  One day I brought my razor in to use when my leg was in a state of un-wrap.  C took the razor and shaved it for me.  And then, and each time, coated my leg with vaseline to keep it more comfortable under the wrap.   Every dressing change took about an hour and she was never in a hurry.  She carefully removed the excess skin around the wound, then washed my whole foot, every time.   Then she figured out the best configuration of gauze pads to absorb the fluids.  At times I got teary over the gentle care that was given.  These women are angels with a gift to minister to the suffering.



Happy times at Butchart Gardens, Victoria Canada, May 10, 2013
I'm mostly healed and walking!






Monday, May 27, 2013

Bunion Surgery and Recovery 2013 (Part 2) AKA: My Pound of Flesh

My Pound of Flesh

Last weekend was the 4-month mark since my bunion surgery.  To celebrate, I went on a 3.5 mile city walk with a group of friends, and also rode my bike up to and around my son's neighborhood about 3 miles away.  These were fulfilling victories!  Why did it take 4 months to be able to do those simple physical activities?   Well, on January 25 I gave up my life of activity,  exercise, and service, and embraced the life of an invalid, though I anticipated living that role for only 6 weeks.  But Shylock demanded his pound of flesh, and I gave it up.  Literally.  And willingly, to save my foot.   Thus the extra long recovery.

Continuing from Part 1 of this story:

[NOTE: I have included some icky photographs of the wound at the end of the post.  After the last part of the text there will be a gap, then the photos.  That way you can look at them only if you want to.]

The plan for reconstructive surgery was in 2 parts:  first, to clean out the mess of infection in my foot and plant some antibiotic granules in the cavity.  Second, two days later the doc would take a hunk of tissue out of my arm  to fill in the cavity in my foot.  That would be watched for 3 days, then I could probably go home.  So, Monday morning, March 18, this ordeal began in Emanuel Hospital's burn unit,  the best place to treat a bad case of tissue damage.  Coming out of surgery I was surprised and grateful to find that the doctor had done both steps in the one surgery--yes!!  It had taken maybe 5 or 6 hours.  Using a high powered magnifier he tied the blood vessels from the transplanted tissue into the foot blood vessels.

I was in the ICU and awakened about every 15 minutes by a nurse w/ a probe.  He or she put the probe into the wound in my foot to test the blood flow.  Sometimes it was hard to find, and it sure wasn't pleasant having that probe rooting around in my raw flesh.  But during every single probe I made sure that I too could hear the whoosh of the blood flow, it was that important to me to know the transplant had worked.  After a while the probe went to every half hour and after a couple of days it was down to every hour.

fun times in the ICU

No one likes a hospital stay, and this one was tough for me.  Tubes and lines were hooked everywhere, and the catheter prevented me from changing positions in the bed.  I had almost no appetite the entire week; just the thought of food was nauseating.  There was an odd smell in there that made me more nauseous as the week went on.  I never figured out what it was.  After 5 days of it I finally barfed.

As for my foot, the first time the doc unwrapped it I was appalled at seeing this ghastly mound of ragged flesh perched on top of my foot, only held down by a couple of stitches.  The piece of flesh taken from my arm was about 7" long, 1.5" wide, 1" thick.  And there it was in all its giganticness.  It was not stitched down until just before I went home, because the doc had to make sure the transplant was successful first.   Pain was controlled by a spinal, and various antibiotics were streaming through an IV 24/7.  36 hours after the surgery a picc line was put in my right arm in preparation for home use.

Besides Dr. V, the plastic surgeon, Dr. C. and some of his staff of infectious disease specialists became my new best friends.  Resident physicians also made the rounds.  One of them told me a story about a friend who was paralyzed in an accident, and found that by accepting his limitations and finding new and tame activities, he was enjoying his life.  I just stared at him and he went on to talk about other things.  When he stopped in again later, I asked if he had been trying to tell me something.  He had.  And thankfully he was wrong.

Near the end of the hospital stay the physical therapists came in to help me start walking with crutches.  Amazing, all the effort it took to get out of bed just to move to a chair next to the bed.  The bathroom was the next frontier.  Then a walk down the hall which might as well have been the Oregon Trail.

That Friday Doc V stitched down the rest of the tissue transplant.  I am deeply grateful that it "took."  Modern medicine is full of miracles.  Doc pronounced me ready to go home Friday afternoon.

For the next 4 weeks I daily infused antibiotics (ertepennum) at home via a picc line, under the instruction of a home nurse, with Craig doing the hookup.    Every other day my foot had to be re-bandaged.  That was an ordeal as it involved:

a precise, methodical cleaning, including stripping off excess flesh
placement of Xeroform (a petroleum-pregnated patch of gauze) on the wound
layers and layers of thick pads strategically placed
yards of gauze bandage wrapped to hold all that together
tape to keep the entire thing stable
eventually a pressure sock was added to the above

And twice a week I visited the "wound clinic" which I'll post about tomorrow (and it will be the last post on this).

As of right now I really don't need a bandage, just padding to protect the top of my foot.  In June I'll have surgery to reduce the size, so that I can wear regular shoes again.

 Icky photos below




























Day after surgery: my borrowed pound of flesh partly covered by a Xeroform gauze.  The purple X was made by the doc when that chunk of flesh was part of my arm; it designated the donor site




a few days later without the bandage, and this time it is stitched down



side view of the transplant


the donor site on my upper arm; I generously offered a big chunk of flab from my belly but the doc declined it


about 3 weeks after surgery; it really is healing!


a month after surgery, looking great


2 months after surgery, edges completely healed; this is a weird photo--it isn't really red and this wide, that's just poor lighting


2 months after surgery, side view

Sunday, May 26, 2013

Bunion Surgery and Recovery 2013 (Part 1)

A bunion is a debilitating and painful deformity in the foot, as seen above

At the end of January 2013 I had an elective bunion surgery on my left foot; the right one had been satisfactorily fixed just over 3 years previously, and it had taken me this long to store up the guts to do the other foot.  Surgery is always risky and I debated back and forth about the wisdom of doing it.   After all, I could walk and run and ride my bike the way my foot was.  The old adage, "if it ain't broke, don't fix it" came to mind.  But it was "broke."   I hike and x-c ski regularly, and I call it "broke" when I have to pad my foot with layer upon layer of foam and moleskin and duct tape every single time I set off on an adventure.  And still suffer unpleasant pain.

This operation was less painful and healed faster than the previous one.  The internal hardware had improved since my last surgery, according to Doc T, and the pin in my second toe was internal, rather than external.  The stitching was underneath the skin which was more pleasant and attractive.  I went off the pain medicine after just a few weeks this time.  Even though Doc T said to wait 6 weeks before putting weight on the foot, I began at about the 4 week point putting my foot on the floor to get it used to a little bit of weight.  It was exciting to anticipate a return to normal fairly quickly.

I should mention the scooter here.  After my first bunion surgery I was on crutches for 11 weeks; what an uncomfortable dangerous time (I fell twice).  This time we rented a knee-scooter and what a joyous life-saver that was.  I could get around fast and have a little fun while doing it!   Best of all it's much safer than crutches.

[NOTE: these first 4 photos are innocuous.  Below them is more text.   Then there will be a 4" blank area to  protect those who don't want to see an unpleasant photo.  That will follow after the space]

The hardware in my newly repaired foot

All bandaged up

This is the life!  NOT

Me, my scooter, and Lil' Buddy, 3 weeks after surgery

On the down side, I got what the doc calls a fracture blister on my foot, which is basically a hematoma.  During my recovery that thing was always weepy and messy.  As my foot healed an ugly black scab formed on the top on both sides of the incision.  Doc T didn't seem worried about it.  Just over 6 weeks after the surgery we left town for a family reunion.   At my doc appointment the day before the trip he thought everything looked ok, though the surface healing was slow.  The bones had knit together as they should.

During our trip I kept my foot under wraps, because that black scab was very ugly.  And it began to smell off.  And then the incision seemed to be pulling apart, yes, my foot was unhealing.  Yikes.   I thought about going to the ER, but instead made an appointment w/ Doc T for the morning after our arrival home.

He took a look and alarmed the heck out of me when he said that I may need to see a plastic surgeon.  He carefully removed the black scab and we were all appalled to see the tissue beneath had deteriorated, and I was looking at the inside of my foot; the tendon was exposed.  A surgical-site infection had severely damaged the tissue in my foot. So by the time I left the office that day the plastic surgeon's office had been alerted and Doc T's notes had been faxed over.  I knew then I was facing a mammoth problem.  Even more so when the plastic surgeon's office got me right in that afternoon.   How often does that happen?  Surgery was scheduled for a few days hence, with a followup surgery 2 days after that; all in all the plastic surgeon expected me to be in hospital for 5 days.

My head was spinning.  And I was in shock.  And afraid.  I called my friend S for consolation; she was rationally optimistic which helped immensely.

Part 2 tomorrow: My Pound of Flesh

[BLANK SPACE, then 1 more photo]





















4 weeks after the surgery; the bones were healing well, the incision was not