Last summer, around June/July, I had a few small painful sores come up on my shin. I was concerned, but they healed after some time. Trying not to jump to conclusions, I assured myself they were either ingrown hairs or a side effect of all the damage from the original break and multiple surgeries and edema in my lower leg.
In September I started having bone and muscle pain. I am a cashier, so I shrugged the pain off to standing all day for long shifts. My previous issues with my leg crossed my mind, but I wanted to believe everything was o.k.
On October fourth, while volunteering at a community harvest festival, I remember turning to my mum and telling her that I thought my bone infection might be back. She was, understandably, a bit upset with the timing of my announcement.
Later in October, I had a sleep over with my best friend, Beth. I remember looking at my leg that night and thinking something was wrong. My leg was itchy, red, and hot. A few days later I had a rash over my right shin, across the scar from the multiple surgeries I have had.
By the end of October, the rash had not only failed to heal, but it had continued to worsen and spread. The itch was indescribable. I also began to experience more bone pain. At the end of the month, I called my Infectious Disease specialist. I had an appointment with her on November 3. I remember telling her that I hoped the rash was not related to the bone infection that we thought I had gotten rid of by the end of 2012 when I stopped all antibiotics in October 2012. She agreed that it could be unrelated but said that it was quite odd that I always had issues in the exact same spot on my right shin. She ordered an MRI asap.
It took a long time to finally get the MRI booked. After several weeks of waiting for an appointment, I called the MRI department, who said that they had recieved the MRI request but had not done anyting with it yet. I scheduled the MRI myself at that point. Meanwhile, the rash continued to itch, the skin would half heal and then flake off, and my leg continued to hurt.
The MRI was on December 23, 2014. Two days before Christmas. I was terrified that the hospital would reschedule, like they did with surgery in 2012 due to short staffing caused by the Easter weekend. All of my previous MRIs have been done with a contrast dye, injected half way through the scan. For some reason, the MRI tech did not want to use the dye this time. I thought nothing of it, thankful that the scan would likely take less time. Half way through the scan, the MRI tech comes in and says that they need to use the dye anyways, because the images looked almost identical to those from the last MRI in fall 2012. This would indicate only minimal or no healing at all. I remember lying in the MRI machine, thinking that I could not go though treating a chronic bone infection again.
I received the MRI results from my ID specialist on January 15. She strongly suspected that I had a lingering infection in my tibia, slowly simmering away. To confirm/throw out this suspicion and to create a baseline for future care, she ordered a bone scan and a WBC scan.
The bone scan was in the last week of January. I know from what the nuclear medicine techs said that there is increased bone activity in my tibia. The WBC scan was in the first week of February (last week Wednesday and Thursday).
Last week Friday, my infectious disease specialist called my just after 6 pm. She told me that the bone scan that I had in the last week of January showed increased bone activity, but that the WBC scan showed "nothing concerning". WBC bone scan, which indicates infection, pretty much trumps bone scan, which can still show healing from my last surgery in April 2012 (debridement, removal of dead bone, putting in antibiotic beads). My ID specialist said that she wants me to come back in ten months for a repeat MRI, just to make sure that spot on my right tibia is healing properly. She assured me that I could come back and see her earlier if I have any issues. I went from thinking that there was a lingering bone infection to being toldthat everything was o.k., and that for the next ten months I should presume that there is no active infection.
I spent the weekend letting all the stress from the scans fade away and catching up on sleep. I was accepting that things were o.k. That my bone infection was not back, despite a lingering feeling of unease, thinking "But why is there still increased bone activity three years afetr surgery?" and "What is the spot on my tibia on the MRI if not an infection?"
Sunday night came around and I was tired. My leg hurt a bit and felt a bit puffy. I ignored this... too busy with school work and getting ready to go back to Hamilton for the school week.
On Monday my leg was more swollen and hot. My shin, around my surgical scar, was an angry red colour. Several small abscesses on my chin formed, opened up, and began draining fluid. The one nearest my ankle, at the end of the scar, began to drain a bit of pus. By the evening I was not feeling good - chills, leg throbbing and stinging, some bone pain. Freaked out by the pus, I decided to go to the emergency room. I got there at about 9:30 pm. The doctor was quite concerned about my leg, but the blood work he had done came back negative. Those results, coupled with the WBC scan results, didn't suggest anything super serious, so I was given a perscription for 7 days of Cephalex, and told to return to the E.R. if my leg hurt more, drained more pus, or if I got a fever. The E.R. doctor told me to call my ID specialist in the morning, and himself sent a a fax to the ID specialist about what was going on. By the time I was done, it was 2:30 am and all buses had stopped running for the night. The E.R. staff was very kind, giving me vouchers for a cab ride home, and calling me a cab!
I was home and in bed just after 3 am
I slept until almost 10 am, and called my ID specialist almost immediately after I woke up. I got the answering machine of her assistant so i left a message along with my cell phone number. in the afternoon I went to get my prescription filled. I was really tired and in pain, so I skipped all of my classes.
The next day was Wednesday. My leg was more puffy and hot and started draining more pus. I decided to tough it out an go to lab in the morning. I couldn't afford to miss more lab classes, since I had already missed the previous week due to the WBC scan. I learned how to perform a musculoskeletal assessment and continued practicing how to transfer and position patients.
My keg throbbed and burned and continued to drain pus. It felt much worse than it did on Monday. My ID doctor had still not called me back. After lab, I went directly back to the E.R.
The E.R. doctor was concerned with my leg. The spot over my shin had turned a deep red colour and was very swollen. He called over another E.R. doctor to look at it. She agreed that it did not look good. They worked hard to contact my ID specialist - she was out of town for the week, which is why she had not responded to my message. She doubled the length of the antibiotic I had been prescribed in Monday (Cephalex) from 7 days to 14 days, and added another antibiotic (Doxycycline) for 14 days as well. The E.R. also got x rays of my leg, which were "better than" the previous x rays. Mind you, my previous x rays were from sometime in 2012. The E.R. was very busy so i did not have time to ask whether "better than" meant fully healed or only partially healed but better than right after surgery.
I went home in the evening and immediately got the Doxycycline prescription filled. When I got home I was tired, so wanted to lie down for a bit. Before I know it, it was past midnight. I had fallen asleep in my clothes, with the light on, on top of my bed. I too my antibiotics and immediately felt sick, throwing up about an hour later (thank you Doxycycline!!! not...). I went back to bed around 2 am, and slept until 11 am. My surgeon's office called and set up an appointment with me for today (Friday) at three pm.
I had clinical practice today from 7 am - 1 pm. I went straight from clinical to the hospital for my appointment with my orthopedic surgeon. By the time I got home I would have had to leave immediately, so it was easier to go straight to the hospital, even if I would be early. Fortunately one of the members of my clinical group, Eva, had to take the same bus downtown from clinical, so we stopped at Tim Hortons for cookies an hot chocolate before I had to catch the other bus to the hospital.
I ended up arriving at the hospital at 2 pm, an hour early. I naturally thought I would have to wait at least an hour ti be seen. Usually you are given a time to arrive, and then have to wait anywhere from a few minutes to hours before actually being seen by the surgeon e.g., your check in time might be 3pm, but you might not be seen until 5pm, depending on the complexity of patient needs, emergency cases, how busy it is, etc.
I was called in just after 2pm. Turns out there was a long line for x rays that need to be done before the doctor sees patients. Since I already had x rays done on Wednesday in the ER, I was allowed to jump the line and be seen earlier than expected!
My surgeon is amazing - great bed side manner, great at his surgical skills, caring, compassionate, very knowledgeable. Today, he gave m the time I needed to express my fears and concerns. It was much needed. he started by asking me how I was doing and asked me to explain what had brought me to the E.R. I explained everything that I have posted above. He then examined my MRI, bone scan, WBC scan, and x rays. There was a lot of "What is that" and "what the..." when he looked at the MRI. He clearly did not like what he was seeing, nor did he fully know how to explain what it was. He turned to me as said "You have just won the right to get a second opinion by Dr. ----, another orthopedic surgeon at this hospital." He was dead serious, but the way he said it was really funny!
He summarized all of the scans/results:
- The MRI shows some type of fluid within my tibia - not sure what it is.
- The bone scan shows increased bone activity, which is not expected
- The WBC scan is negative, but this can be decieiving (I have add this scan 4 or 5 times before, usually inconclusive)
- My blood work is normal (but it has never been abnormal, even when I was really sick with the chronic bone infection in 2011).
- The x rays show the hole he drilled in my bone in April 2012. This does not concern him, but he is concerned with a "shadow" he sees around the drill hole.
He then examined my leg - prodded the areas around the abscess on my leg pretty hard. I said "That hurts, please don't do that. Really, stop, that hurts." He joked "People come to see me to be in pain." I responded "No people come to see you to get rid of their pain!"
He said that given the MRI, bone scan, x rays, and the swelling and drainage from my leg, it was likely that I still have a bone infection. He needs me to get a second opinion from another OS and to consult with my ID specialist.
I then asked my most important question, and bluntly asked "Can you fix it?", to which he responded, "I can, but it won't be fun/easy." During my last surgery, he scraped away the dead bone from my tibia. This is very minor to what he would do this time if the infection has returned. He says he think he can get rid of the infection, but it will be major surgery with several steps.
He said that we could do the same type of surgery as last time, simply scraping away any dead bone. The surgery, he said, did work, or at least for two or three years it worked! He, however, stated that once you have already done one surgery once and gotten a certain response, it is unlikely that a second surgery of the same kind would yield different results. I agreed, stating that was the definition of insanity.
So, if it is indeed infection, he proposes major surgery instead:
First, he would remove the infected section of my bone and the surrounding area for good measure - about 1.5-2 inches of bone all the way around, and fill in the area with antibiotics beads/sponges. I am unsure about this part, but I assume my leg would be held together with an external fixator.
He would then close me back up and let the antibiotics do their work for 2-3 months.
Then he would open me back up, take out the remaining antibiotic beads/sponges, take a bone graft from my hip, and use it to fill in the missing bone. The ends of my tibia and the piece of hip bone would likely be held together with a metal rod.
I would then have another 3-6 months of recovery time.
This entire process would take 6-9 months.
This is, indeed, major surgery compared to my previous surgeries.
I expressed my concern, stating that I am a nursing student. I can't take time off from school for surgery, not like I did while in university. He completely understood. He said that I would have to finish the RPN program first (Spring 2016) before I could have surgery. This is about 14 1/2 months from now. Not a brilliant thing to look forward to after graduation... =(
That gives us 14 months to figure out what is going on. My surgeon stated it is unlikely that we could grow anything from any swab samples. He mentioned a needle biopsy, but said those are not fun, and it likely won't grow anything anyways. Not even samples taken from surgery in 2012 ever grew anything. Unless we can accidentally stumble on a magic antibiotic pill that can cure whatever is in my leg, surgery is my best option.
What I was told today is so different from what my infectious disease specialist said on the phone a week ago today. I will likely be speaking with her in the next week or so to discuss all this. And, of course, my surgeon and ID specialist will be communicating as well, plus the second opinion from another orthopedic surgeon.
I don't quite know how to feel or what to think. I agree with my orthopedic surgeon that something is wrong, most likely infection. Knowing is better than not knowing. Now at least I can set things aside, put surgery in a little box at the back of my mind for sometime spring/summer 2016, hopefully, and get on with school work. I am too busy to spend too much time worrying now. Mid terms are next week, and the end of first semester will be her in no time. Some of my clinical groups and I agree that by the time we get to June or July, the rest of the year will pass really quickly, and then, before we know it, we will be at the end of fourth semester in April 2016. That leaves surgery right around the corner...
I have been scared of chronic osteomyelitis and surgery before, but I have never been this afraid of what could happen. This is a major surgery, and it terrifies me. I need it to work. I need to be able to get over this and continue to move on with my life.
I will just have to wait and see now what my ID specialist and the OS for second opinion says.
 | ||
| This is my leg right after surgery in April 2012 to remove the dead bone from my right tibia. You can see where the surgeon scraped away bone - dark gray areas. |
 |
| This is my leg two days ago, on Wednesday, February 11, 2015. In the center is a dark gray spot. This is where the surgeon drilled into the bone. This spot does not concern him, but the shadow around it does. |
 |
| This is a lateral view of my right tibia from the MRI done on December 23, 2014. The dark white spot is where there is fluid within my tibia. There is also, as my ID specialist says, "A heck of a lot of scar tissue." |
 |
| This is the anterior view of my right tibia, from the MRI taken on December 23, 2014. That white spot in the middle is the same as the white spot in the previous photo - fluid in my tibia. |
No comments:
Post a Comment