Again a Trip to the Operating Room

CAUTION!!!! This post has what may be considered a graphic photo!



I went into the next surgery fully anticipating the surgeon to remove a small portion of the bone. I was obviously upset that the infection had penetrated into the bone and also curious how it had managed to happen while I was on the Wound VAC.

This surgery was obviously going to be more invasive than the previous, so I was more heavily sedated for the procedure. As such, I do not remember anything until I was waking up in the recovery room. When I woke up I felt fine and was wheeled into my room, with the Wound VAC therapy already having been resumed. Being that the infection was in the bone I would need to be admitted to the hospital for a few days so that the infection could be grown in a lab, so that we could ensure that I was treated with the proper medication. In the meantime I was treated with a broad spectrum antibiotic intravenously.

When I was more alert a bit later that day my surgeon came in and explained that he did take a portion of the bone and while he was looking around he asked for a consult with one of the infectious disease doctors. The surgeon is basically responsible for making sure the wound closes, while the infectious disease doctor's responsibility is to treat the infection so that it would be able to close without all sorts of bacteria in it.

I met the infectious disease doctor and was comfortable with him from the beginning. No alarm bells were going off in my head about anyone that was now treating me. I was confident that with the combination of the two doctors that the wound was getting proper treatment and it would close, with time.

Around day four of my hospital stay the two doctors came into my room and said that they were going to discharge me the next day but that I would need to have something called a PICC line inserted first. The PICC line is a peripherally inserted central catheter. A small tube was to be inserted into my upper arm and threaded up into a major vein of the heart and is used to deliver antibiotics on a long term basis.

The next day a nurse came in to get me so that my PICC line could be inserted. Surprisingly, enough I was not especially nervous about this procedure, even though I would be awake and completely aware of the entire thing. Although the PICC line felt uncomfortable going in I would not necessarily call it a painful experience.



After my PICC was inserted I was brought back to my room to get some instruction on how to use the line. It turns out that after a visiting nurse did the initial dose with me that I personally would need to administer my medication myself. That was the only part that made me uneasy, but I figured that it would not be allowed if it weren't a relatively simple thing to do. I went home with the Wound VAC and PICC line and was told that a nurse would meet me at my home to administer the antibiotic with me and to teach me how to do it for myself from then on. The nurse for the PICC line would only come on a weekly basis to change the dressing and to draw labs to monitor the infection.

Frustrations

Due to an error with the paper work being sent for the Wound VAC we were unable to begin using the Wound VAC until almost a week later. I was disappointed that it was going to be postponed but I realized that there was nothing I could do so I just accepted the fact that I needed to wait.

When the VAC finally arrived we began the VAC therapy. It was approximatly a week later that the surgeon wanted to see me again so he could check on how everything was going. The appointment with the surgeon was uneventful and all signs were pointing in a positive direction. The surgeon then explained to me that he was going to be out of town for a few weeks and that I should make an appointment to see him in a month.

During that month I continued to use the Wound VAC and have a few nursing visits a week so that the VAC dressing could be changed and so that the wound could be monitored. Everything with the wound seemed to be going well.

By this point the wound was not what was causing me the most stress. The Clinitron At-Home bed was a different story though. The part of the bed that holds the 'sand' is covered by a polyester sheet, which I did not find to be very durable at all. After having had this bed for so long I was finding that it seemed to be tearing which was causing the sand to go everywhere. This was not only uncomfortable to sleep on but I found it nearly impossible to eat while I was in bed. It felt like even if I had just washed my hands that they had a gritty feel to them. When I called the company to ask what to do about it, I was told that because of insurance I was no longer renting the bed so the replacement cover was not going to be replaced for free. Figuring that a piece of polyester really couldn't cost that much I inquired as to the cost. When they told me how much it was going to cost I asked if they had any suggestions how I could fix it without replacing it. I was basically told that I should try to use either electrical tape or duct tape over the tears. That suggestion was fine but only for a very temporary basis. The heat of the bed all but destroys the adhesive on the tape so it basically needed to be re-taped a few times a week.

sand on the side 

sand going up to the top

While this was incredibly frustrating I kept reminding myself that it really would be only needed temporarily, due to the fact that I was on the Wound VAC and so the wound should close. Things seemed to be going well until about a week before I was supposed to see the surgeon. That week I was starting to feel more pain from the wound. I had been told previously that sometimes pain is due to healing so I was not super concerned about it. The other thing that kept me from worrying was the fact that the pain could be relieved with medication. I figured that if something were really wrong that the pain would be more constant and that the medication would not be as effective in stopping it. I mentioned the pain to my nurse during a couple visits and she was only mildly concerned about it based on her opinion of how the wound looked.

I did not really consider making a phone call to the wound care center until a couple of days before my appointment was already scheduled for. I figured that I had dealt with it and it wasn't very severe so it could wait until I saw my surgeon. The day of my appointment arrived and I mentioned to the nurse and the surgeon that I was experiencing some pain. When the surgeon examined the wound was when I felt a whole bunch more pain. It turns out, that bone was now exposed and that I would need surgery. The appointment was on a Tuesday and he looked at me and basically said, 'ok, Friday or Monday which works for you?' I chose Friday being that I figured based on the options I was given that sooner was probably better than later.

Meeting the Waste of Time

I feel that the wound was already infected before that one nurse decided to put the different dressing on and that by no one seeing it for a few days it allowed the infection to fester. Leaving me with a huge wound that had actually turned black.

As I had been instructed, I went to the wound care center the following week so that I could begin seeing the doctor that was supposedly going to heal the wound. The doctor came into the exam room and before she had even really introduced herself to me she began working on the wound, continuing to cut away the dead tissue. Her failure to introduce herself was the event that set off the first alarm bell in my head. While I understand that doctors are busy people I do not feel that it is in any way appropriate for a doctor not to take the thirty seconds and introduce themselves to a new patient.

While the doctor was lookiing at the wound is when she started asking questions regarding how long I had had the wound and what we were doing for it. I answered her questions and then was sent for an x-ray to make sure the infection hadn't spread into the bone. While I was waiting for the x-ray I was hoping that it hadn't progressed that deeply but something in my head told me different. The x-rays were inconclusive, which meant that she couldn't tell if bone was involved or not. If bone were involved without us knowing it would have been disastrous. Being that she was unable to tell through x-rays that meant she would have to bring me to the Operating Room to find out.

The surgery was scheduled for a few days later. I was admitted to the hospital the day before my surgery was to take place. During that time I saw a wound care nurse that suggested that something called a Wound Vac be put on the wound. When she first told me that I was sort of shocked, 'I'm sorry you want to hook me up to a machine and let the machine make it better,' I thought. Instead of panicking at that point, my somewhat of a nerd brain took over and I started asking for literature about this 'Vac' that they wanted to hook me up to. The wound care nurse gave me a large binder with a ton of information in it. When a family member came in to visit me later that afternoon he found me studying. After I had finished reading all of the literature I was all but certain that while this device may not be the most pleasant of experiences that it would probably be effective. At this point the little voice in my head that had been telling me that this doctor may not be a good match for me got louder. I requested a second opinion from a doctor that I trusted and had seen previously for various issues.

When he came in and looked at the wound he told me that yes surgery was going to be what I should do. Surprisingly I was okay with that answer. That is when I asked him if he would do it instead of 'my surgeon'. He said no, that he wasn't really into wound care and that I should stick to the surgeon I was already working with. I agreed, though somewhat hesitantly.

It's All Getting Ugly

The worst decision I could have made was allowing that one nurse to change my woundcare. She said we were going to do something different and I should have insisted on another opinion when I first heard those warning bells.

We had been changing the wound dressings three times a week and it was going very well. Until that one nurse decided that being that it was almost done we would change to a type of dressing that was to be left on for a week. She basically told me that when she came back a week later that I'd be all but healed. It did not happen like she said it would.

To begin with, the dressing only stayed on for three or four days before it fell off. When it fell off I noticed 'that smell' the 'sour milk, something is really wrong here smell' that anyone that has been around an infected wound knows instantly. Of course I called the agency and told them eventhough I wasn't scheduled for a few days that I required a visit inmediatly. It being a Saturday the on-call nurse was one I had never met before, but at that point I didn't particularly care. She came and put on a new dressing and said she would be back the following day to change it again. Finally, I thought someone that knows what she's doing.

When she came back the following day to change the dressing she explained that it looked 'different' from even the previous day. She covered the wound and told me that she was going to call my doctor's office when she left and that I could expect a call back from her. She explained that yes the wound was infected and that she thought it needed to be seen by a doctor ASAP.

The nurse called me shortly after she left and told me that the doctor wanted me to go to the Emergency Room and to get the infection disease doctors to look at me. I went to the emergency room with an enormous pit in my stomach, very worried about what was happening. The infection doctors at the emergency room looked at the wound, took cultures and had me admitted so that it could be detemined which antibiotic they should put me on.

I was placed on antibiotics and two days later they were ready to discharge me. When the patient coordinator came into my room to set up all of the home nursing care I would need, I finally decided to speak up about that one nurse that I never wanted to see ever again. The patient coordinator listened to my story and completely understood my concerns. She made arrangements for a different company to take over my homecare. I was relieved that it would be a different company this time around, yet was also worried that something would go horribly wrong again.

In addition to being discharged to homecare I was instructed to start seeing a wound care center in a neighboring town. The first visit to the wound care center wasn't really a big deal, other than the doctor I saw wouldn't be the one that would be treating me regularly. He was just filling in while that doctor was dealing with an emergency. All he did at the first appointment was to start cutting away all of the infected tissue. As he was cutting it away I was sort of surprised to notice that I was in no pain what so ever. Of course dead tissue has no feeling so I suppose that makes sense. The other thing that struck me was the horrendous odor that was coming from the wound. It smelled like burning rotten flesh which of course makes sense cause for all intents and purposes that's exactly what it was. The doctor told me to go back the following week so that the doctor that was going to see me regularly could do her evaluation.