Friday, August 26, 2011

Back to business

Amidst all the banter pertaining to the troll, it was said to me that I was apparently putting too much into being aloof. I honestly wasn't trying that hard, but abandoning the running commentary should be taken seriously. There are other matters at hand.

Or at foot, as the case may be. This is going to be another graphic one, so discontinue reading if your stomach is as sensitive as mine turned out to be.

My podiatry visit this morning began with my telling the doctor we needed to have a serious discussion about the second toe on my left foot. Then I went into my ER visit. He asked if they'd x-rayed the toe or taken a culture of what was coming out of the wound. "No," I told him. "I suggested a culture, but they didn't deem the wound that serious."

Had the doctor on duty that night bothered to debride the wound, he might have had a different opinion. My podiatrist did exactly that, and exposed entirely too much bone for my stomach's liking. I took very deep breaths to keep myself from tossing my cookies on Becky, the doctor, and/or the wound. The flesh around the wound is simply dying, with no visible happy ending for the toe.

I made that the question to my doctor. "Do you honestly see a happy ending for this toe?" No, he didn't. In fact, because of the wound's behavior, he stated that he was 98% sure I had osteomyelitis. He ordered more x-rays, but agreed that it was time for this toe to go. Not the whole toe, but at least the end of it. I was smart enough to bring the orders from my PCP for blood work, which would be required for surgery. I asked if there was anything else needed for the pre-surgical test work, and was told it seemed enough was being done.

We then covered how the procedure would go. It would start with an injection of what my doctor called "Michael Jackson Juice." Basically, the same drug that had been mismanaged and killed Michael Jackson would be used. In professional terms, it's actually called "twilight anesthesia." I'd likely sleep, but could be prodded to respond to instructions should the need arise. Then he would make two incisions that left enough skin to use as flaps over where half of the toe would come off. He'll cut through what connective tissues there are, take the end of the toe off, then seal it up by stitching the flaps closed. Before he committed to closing me up, he'll take a sample of the next bone and have it cultured for possibly more infection.

Now, much to my surprise, this whole thing is ambulatory surgery. In by early morning, out by mid-afternoon. That particular idea has me worried. My penchant for infection means that this surgery could very well turn this fix into a greater disaster. So it was that I requested I be admitted for at least three days to receive IV antibiotics. Then, if they want to send my home to finish off with oral antibiotics, so be it.

My podiatrist appreciated my concern fully, and said he would consult with my PCP. If necessary, he said he would try to contact what he called "a hospitalist." The latter would inevitably involve a small army of infectious disease doctors, who would likely leap upon the idea of cutting off parts to save the whole.

So why go this route? Why cut off the end of my toe when it is only a wound that, after taking a peek at the x-rays, doesn't appear to have osteomyelitis? It's position, being on the second toe and in constant contact with the great toe, it is constantly being agitated. Even when wrapped in gauze, the gauze itself perpetually rubs against the wound. Each time my doctor debrides the wound, he ends up removing more and more useless flesh, exposing even more bone. In short, it's not healing AT ALL!

Tomorrow, I'll be seeing my podiatrist again. The purpose is to discuss the probable surgery further, as well as replacing the cast that's been on my right foot for longer than three weeks. Mind you, there is a possibility of not receiving a cast, and hobbling out only in my CAM walker. Should the latter happen, there will be a great, celebratory shower that, for the first time in months, will not involve a careful balancing act. And then, without this damnable cast on my right foot...

Y'know, I think this is the perfect place to simply end my post, as my blog is about to leap from being PG-13 to something more...adult.

Be well, all, and DFTBA!

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