Hurray! 100th Post!!!
Before I mention anything else, I would like to point out that this it my 100th blog post! This is exciting news for me. Actually, it kind of sucks, because it means that my bone infection is still hanging around, nasty little bacteria cells sticking to my bone like a child who super glues his fingers together during art class (we all remember that one kid who did!). But it is exciting none-the-less - it means I am recording this experience as I hoped to do when i set up this page, and committed enough to actual get on with it!
After my last post, about a week and a half ago, I took a short break from blogging. I needed a few quite days to myself, and to focus on a big pathology/pharmacology/physiology test, which was on Monday at noon. Since then I have been studying for a psychology test and waiting for an appointment with my orthopedic surgeon, which was today at ten.
I had another spot on my shin a few weeks ago, which I mentioned on here. It has since healed. I had a few wonderful days without any bone pain last week, but that changed Monday evening while I was taking a walk. Since then I have regularly been having a deep aching feeling in my calf, like something is taking a bite out of my leg, and a strong ache on the right side, right in the bone. Yesterday I woke up with the horrible ten times worse than growing pains feeling, and my twelve hour clinical shift didn't help any. I am happy to have the day off to kick my feet up and relax a bit while studying cardiovascular drugs. The night sweats continue, making it hard to get a good nights sleep. Sometimes, when it happens more than once a night, I am too tired to get up for the second or third time to find clean sheets and pajamas - I just strip and roll over. I did finish the antibiotics (Doxycycline) I have been on for the past fifteen weeks. This medication causes photo sensitivity, so I have been burning super easily. I hope that goes away quickly now that I am finished the medication (and that my leg doesn't flare up again so that I won't have to restart it).
The surgeon agreed to perform surgery as soon as I said that another spot had formed on my shin. he has apparently talked to both my infectious disease specialist and the orthopedic surgeon I saw a while back for a second opinion. They had agreed that I would need surgery if more spots appeared on my shin, which has now happened. It is a bit concerning since this happened while I was on antibiotics. The surgeon spent at least twenty minutes talking to my mum and I. It was greatly appreciated - we know he is busy and has a lot of patients to see, but this was a big one, hearing all the details of what would happen, etc. He has a great bedside manner, explains everything thoroughly, and never seems rushed or bothered with questions. Before I left the fracture clinic I signed consent forms so that surgery can be scheduled. This is the plan:
At the end of August or start of September, I will have surgery to removed the dead/infected section of my right tibia. The infected section is about 1.5 inched long, so the surgeon will take out about 2 inched of bone in order to get clean margins. The surgeon explained it this way: chronic bone infections are treated like cancer (even though it is not). He needs to get good margins in order to get out as much of the dead/infected bone as possible. Tones of antibiotics will then be used to kill any cells still lingering in the bone and surrounding tissue. The reason that the bone infection came back after the last surgery was because there were still bad, infected cells floating around inside my leg. Hence this surgery, which is more extreme but should hopefully get rid of everything, or almost everything, leaving any remaining cells to be killed by antibiotics. The two ends of my tibia will be healed together with bone cement that releases antibiotics. the chunk of bone removed will be sent to the lab and cultures take.
After the first surgery, my leg will be in a cast. I won't be able to walk on it at all until the the second surgery. I will be pumped full of antibiotics, either oral, IV (through a PICC line), or both, depending on what, or if any, cultures are grown in the lab. My cultures/blood work have never grown anything, except for way back in 2008 when we got stap. aureus and coagulase negative staph. If the cultures grown something, I will be given specific antibiotics targeted to the bacteria or whatever it is. If nothing grows, the doctors will throw lots of different antibiotics at me, hoping that something works. If this happens, my surgeon said I will feel very very sick, so I am hoping something grows! It is up to my infectious disease specialist to determine what antibiotics I will be placed on. After about two months or so, we will end the antibiotics and see what happens. If my leg, blood work, and scans/x rays, etc. look good seevral weeks later, I will have surgery number two.
Surgery number two is about filling in the next section of my tibia. The surgeon will use cadaver bone and bone from one of my hips to fill in the missing section of my tibia. This bone will be held in place with a metal rod that runs through my tibia. I will be able to place about half my weight on the leg after this surgery. It will take about three months to heal from this.
The entire process should take 6-9 month, if everything goes as expected - I am young and other wise healthy, so fingers crossed! And really, I can only fall in the 1% of patients who have something of wrong so many times before I will end in the other 99% that heal properly and are infection free. The surgeon gave me about 70-75% odds that everything goes as planned. I like those odds!
The surgeon did say that this was much more extreme than the previous surgery, which only involved scrapping away the dead and infected bone from my tibia. With this surgery, they are just going to cut a large hunk of bone out. He said to expect it to hurt a lot more, especially the bone graft. Apparently harvesting the bone from one of my hips hurts a whole lot more than the actual site of the bone graft. I will be in the hospital anywhere from 1-2 days to a week for both surgeries, depending on how quickly my pain gets under control. To be honest, with this surgery, and possible a PICC line, and the fact that I will be missing a chunk of my tibia, I won't mind staying a few more days in hospital than in the past.
My surgeon used the x-rays I had in the E.R. in February to show me where the infection is and how much bone he would take out. I got pictures, as usual, with my phone. I took out my phone while the suegeon went to get a consent form. He came back before I was done. I said "just taking some pictures of my x-rays." He replied "Of course," and gave me two different shots. I have done this before; he knows me well.
The surgeon measured the suzpected size of the infection first:
and then the size of the piece of tibia that would likely have to come out:
Since I had an MRI in December, bone scan and WBC scan in January, x rays in February, and CT scan in April, I don't need anything else for a while. My mum asked him if there was anyway there could be more infection in my leg than shown by the MRI and x rays, but the surgeon said given all the scans I had done it is not likely there will be anything surprising in the first surgery. I half heartfelt said "maybe you won't find anything at all," but that is wishful and foolish thinking. Before leaving, I signed a consent form to get the ball rolling. Hopefully in a week or two I will get my pre-op package in the mail with all the information I need. And that is the plan. It is scary and time consuming, but it should be successful in getting rid of the resident leech, slowly nibbling at my bone.
I am both excited to get rid of this darned thing and sad. Nobody wants to have surgery, let alone two surgeries, one of which is inevitable after the first one it done. But I think this is my best shoot, as does my surgeon. And I still have three months left to enjoy the summer. I think it will go by quickly. 1/4 of the semester is already done. As of today, only 11 more weeks to go!
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