Sunday, September 18, 2011

Hospital Adventures: Part 2

I left you with the doctor just having removed my toe, but I failed to mention something that happened before that...

Becky and I debated whether or not to call my father about the pending surgery. Honestly, I don't know what I should have PROPERLY said. In my emotional hurt and frustration, as well as the stress I was experiencing, I would have tried to call when they weren't in and left a message, "I know you don't care, but I'm going in to have the surgery that you waved off as nonsensical." I honestly don't think I would have scored any points on that one. And if Becky called...Well, I could see her taking the blame for whatever crime they believe was committed against them. As a result of such thinking, no call was ever made. And since they may well be following this blog, as I'm sure my infantile brother is from time to time, they know my number. They could have called it at any time.

And now back to the day of the surgery. It went well. The troublesome toe was gone. There was no pathology on which to report.

Becky was waiting for me back at my room. To be honest, I don't remember much of that visit. I was still quite out of it, but I distinctly recall her being there, filled with her customary amount of love. G-d, she is so good to me and for me! After a short time, she left for classes, and I rested...

...until an infectious disease doctor showed up. (Honestly, if you expect to get any rest whatsoever, don't have such expectations in a hospital.) He confirmed that one of the cultures taken on the day of my admission was a staph infection, but didn't know what kind of staph it was. What they were keen to learn was if it was or wasn't antibiotic resistant. That answer wouldn't come until the next day. Still, he started me on two IV antibiotics to cover his bets. One was a broad-spectrum drug, while the other was designed to go after resistant staph. The latter I'd been on before. It's called Vancomycin and it can burn quite a bit going in; I'd had a number of IV sites changed because it would "burn out" the vein into which it'd been going.

Here's where I became INCREDIBLY stupid. You see, went a long time without a cigarette. About eight hours, if my guess is right. I should have stayed in bed and just done my best to ignore the urge. Instead, I got a hold of a wheelchair and made my way outside for a smoke. It didn't taste very good, and it made me lightheaded. I should have gone back inside and made some kind of attempt to quit. Instead, I made it as far as the next morning and found myself making my way outside once more after a dose of painkiller. Really, I am dumb beyond belief. Before I knew it, I was heading outside every two hours for another fix. Amazingly, opportunity was still knocking, as I couldn't bring myself to smoke a whole cigarette. I should have responded to the lack of enthusiasm to my 24-year habit.

Day number three brought me back into the Twilight Zone. The day before, I'd called Becky and she woke up easily. On this day, I called and she was ALREADY AWAKE! At 8:10 in the morning, without fighting me to get up? I recall saying something akin to, "I don't know who you are, but if you tell me where the real Rebecca is, I won't press charges." She said she had a lot to do before she came to the hospital, so I didn't make further fun of her behaving oddly.

After breakfast, I hobbled outside for another half-cigarette. I took all of four or five puffs before turning around and heading back to my room. Thinking that I should waste the cigarette, I cut off it's burning end and stuffed it back into the pack. By the time I got back to my room, I recalled what a stink a half-smoked cigarette could create and flushed it down the toilet. Natural instinct versus addictive urges. I should have listened to the former.

Amazingly, I STILL hadn't needed any of my short-acting insulin. That was about to change. You see, I wasn't just eating regular meals now, but was also receiving my IV antibiotics in a solution of dextrose. I asked about this and was fed some silly line from a nurse that the dextrose increased the strength of the antibiotic. It seemed to me that all it did was increase my blood sugar. By lunch, my glucose level was 243. (I took a few notes while I was hospitalized, which is how I can produce the occasional detail.) That level indicated that there was 243 milligrams of of sugar per 100 cubic centimeters of blood...and normal, as mentioned yesterday, is 70 to 110. My dream of having suddenly been cured of diabetes went out the window. (Hey! A guy can dream, right?)

In terms of pain, I was experiencing some ache in my feet, but a majority of my pain was in my hip. When I say "feet," I DO mean both of them. There was a bit of pain coming from the surgical site - just a bit of soreness, really. In my other foot, still in this damnable cast, there was a steady ache coming from the talus, where I'd had so many microfractures. But when it came to my hip, I was in true agony. Lying down seemed to cause the most pain. Sitting made it somewhat bearable. Standing and walking reduced it the most, so really...what the heck is going on in there?!?

The hospitalist came by, and my pain wasn't really on my mind enough to discuss it with him. Instead, we discussed my rising blood glucose levels, and he decided to raise my 24-hour insulin slightly. I came in taking 0.5 CCs of Lantus daily. He lowered it the day before to 0.3 CCs. Now he was raising it to 0.4 CCs. But as long as they were using dextrose with my IV antibiotics, I didn't expect much of a change.

And I must say, the timing of my IV meds made life in the hospital...annoying. My need for a lengthy nap yesterday came from the fact that I received the broad-spectrum antibiotic every six hours - 6:00 AM, 12:00 PM, 6:00 PM, and 12:00 AM - and the Vancomycin every 12 hours - 4:00 PM and 4:00 PM. Those doses that came along while I was sleeping were a lot of fun. Each time I was given medication, they had to use a laser scanner on my hospital ID bracelet. If I was sleeping in a position where it was hidden, they had to dig my arm out to scan it. Then, to connect the IV, they might have to do the same with the other arm to find the IV port. As an added bonus, the "Vanco" burned, so...yeah. Sleep was a bit difficult. And every time I was awakened, I became that much more conscious of my pain, which meant I was soon asking for a dose of Diloted again.

That drug was somewhat enjoyable. I mean, there's a reason why people become addicted to such things. When injected into a vein, there's an instant feeling of euphoria. That said, I was actually proud of the fact that while I was in the hospital, I was able to cut one of my narcotics from my list of meds. The major use of my Valium is to sleep. (PTSD and all that.) But while I was there, I was able to receive 25 mg. of Benadryl through my IV, and it would knock me flat. On the very first night, they gave me a dose of Benadryl, and I didn't feel much of a difference, so I decided to read a bit. I found myself reading the same sentence over and over again, unable to make sense of it, and taking longer to read it each time. Silly me, I thought it wasn't working; it was working just fine!

During day number three, a nurse came in to talk to me about my discharge. I was excited in that I thought they were going to0 cut me loose, but there were no such orders. No, she wanted to discuss what would happen WHEN said orders would come along. She explained to me that if I required IV antibiotics for a longer period, I was all set to receive everything I needed, as my medical insurance appeared to be excellent from her perspective. A week's worth of the broad-spectrum stuff would cost me $2.40. The Vancomycin would cost $4.60. And everything else was covered. She sounded truly amazed. She was also somewhat pleased that I knew about how to handle such home care. Mind you, she wasn't happy that I'd required it in the past, but did like the fact that I wouldn't be a complete novice when it came to setting up my own IV at home. (They'd install a PICC, or Peripherally Inserted Central Catheter, and all I'd have to do was connect the lines to receive my meds. There would be no starting a new IV at home for me.)

Alas, there was some confusion as to what was or wasn't happening with the whole home care thing. At one point in the morning, a doctor was saying I'd need it...and was saying I wouldn't need it at another point. None of the nurses were sure when he said which one, so the one nurse discussing my home care said she'd leave a note in my chart and let the doctors figure it out later.

My podiatrist stopped by that evening to say he'd be back bright and early to change my dressing. When I mentioned the whole home care thing from earlier that day, he stated, (and not for the first time), that he'd never heard of someone being able to do IV meds at home while on Medicare in his 20 years of practice. When I'd argued that I'd done so in the past, he shrugged it off and suggested that maybe it was an issue in Pennsylvania. He remained skeptical, so I sent him off to read my chart, where I knew a note was awaiting the infectious disease doctors. He was back in short order, telling me that he had great trust in the nurse who'd written the note, and that he now left HER a note asking her to teach him "this strange and powerful magic."

I was going to cut this post here, but there's not much left to tell. So...

My final day started with my podiatrist dropping by at 6:30 AM to change the dressing. He rinsed it with saline, said it looked good, painted it with iodine, and covered it with enough gauze to make it virtually bulletproof. he then instructed me to stay off it as much as possible, rest with it elevated when possible, and to keep it dry. And I loved his instructions for the happenstance of it getting wet. "Wash it with soap and water, dry it thoroughly, apply some iodine again, and put a band-aid over it."

"Really...? A band-aid?" I asked.

"It's not that big," he replied.

Between this foot's surgical site and my other foot being in a cast, it looks like I won't be showering AT ALL for the next couple of weeks. Thank goodness I've lived with similar instructions in the past and know how to remain clean under such circumstances.

An infectious disease doctor was in around noon to tell me that the deep tissue culture had gotten off to a rough start, not growing anything. But then something had started to grow, and they were still awaiting those results. He was positive I'd be spending at least one more night in the hospital...and returned a half hour later to say the results miraculously came in while he was still there, and that it was antibiotic-sensitive staph. I could go home immediately with a prescription for oral meds.

Thus, I was immediately discharged with instructions to call for an appointment with my podiatrist ASAP.

And that's it. I suppose I could now go get a pedicure and insist on a 10% discount due to my now-missing toe...if ever I was of a mind to get a pedicure at all. And while I may not be able to count to 20 anymore, I CAN get as high as 19 and 1/3.

I'm off to try and get Becky out of bed. It would seem that my return home has also meant a return to her fighting wakefulness. Perhaps I really SHOULD call her; it worked better that way.

Be well, all, and DFTBA!


"Blue" said...

Well. At least you had doctors saying they'd seen worse. I once had an allergy so bad, they kept calling doctors IN to see the horrific allergy which was, I heard "the worst" they'd seen.

That's kind of less reassuring :P

WalkingTarget said...

Glad to hear that things went more-or-less to plan. So, this staph infection was the cause of the problems in the first place, then?

Rob Meadows said...

Walking Target: Yeah, these kinds of infections are usually the start of such problems. The most common is staphylococcus epidermis, which apparently grows in great quantities across the human body. It's just there, gleefully waiting for a hole to present itself in the skin. One's capacity to battle such infections is entirely up to the individual.

The great fear is staphylococcus aureus, which tends to end up as being antibiotic-resistant. It's also known MRSA, (pronounced "mursah"). That was the one they were particularly fearful that I had.

The big question was how the infection got inside me. Well, the educated guess on that one was that it might've been a nail infection first, which worked its way inside. Alas, we'll never know for sure. All we know is that the wound was growing, not healing, and that it had to go.

"Blue" said...

Say, Rob. Have you tried Echinacea? It's a herb that can help improve immune system function. I've seen a lot of studies out there that show it can be helpful (though none that say it's a miraculous thing. Beware those things that claim to be miraculous!) for infections and all.

Maybe you could try to talk to your doctor about it? The supplements shouldn't be very expensive, and might be able to help you fight off infections a little better. Of course... tell your doctor first.

Rob Meadows said...

Euthanasia? Please, Ale...I'm not in that bad a shape yet. I...

Oh, wait. *ECHINCEA*! Well, I'll ask my PCP should I remember to do so, but in all honesty, I don't have much faith in herbal "remedies." I tend to see them as "voodoo and mysticism." And that's mostly because I've read several reports that there is little proof the herbal stuff does anything, other than drain your wallet. =(