Thursday, July 16, 2009

More Surgery

Robert and Beth, a couple that we've known for years flew to town on Tuesday to visit us. Or, they thought they were flying here to visit us. It wasn't until they were claiming their luggage that they discovered that "North Bend" isn't a suburb of Bend. So they rented a car and drove the rest of the way.

They called us as soon as they learned of their mistake. We were at my surgeon's office when they called, where we were learning that the day's x-ray of my ankle was showing that the yeast infection was eroding the bone around the screws. The good news was that we weren't late picking them up at RDM, the bad news was that I would be on the operating table on Wednesday for another surgery. General anesthesia, open the incisions, remove one of the two bolts, irrigate and clean and debride and generally hose things out.

Mrs Elliott spent the night in the room with me, last night, on a little recliner that had the frustrating tendency to pop back to the upright seated position with a "boing" sound every so often. But she managed to sleep through it all, though, including the bi-hourly visits from staff for vitals and meds.

Me, I tossed and turned -- or at least wished I could toss and turn, but with one of the fixing bolts been removed (I got them to save it for me), Dr Askew felt it best to put my lower leg into a cast to immobilize the joint so it can heal properly. The cast has three bags of ice on it, which seemingly weigh as much as sandbags, so there was no tossing and turning, just napping alternating with ceiling staring.

But the pain level is much, much better today, I hope I quickly return to the level of low pain and returning strength I was enjoying right before this surprise surgery.

I'm on IV antibiotics and will be on them for a couple of months - yeasts are slow and we want to make sure we get them all. I get something called a "picc" line which will let me plug myself into the IV drip w/o any messy amateur vein-sticking.

In the meantime, Robert and Beth are viewing houses for sale, like good little Californians.

13 comments:

  1. So sorry you're having all these complications, Jack. It's like a year of your life is being eaten up by this. I hope the docs finally get a handle on the problem -- sounds like they're working by trial-and-error so far.

    Are you starting to get just a little teeny bit skeptical about the claim that Bend has terrific medical care?

    Think about it: If you're a hotshot surgeon with top credentials, are you going to set up practice in a major metro area, probably at a big teaching hospital, or in little ol' Bend, Ory-gun?

    When I moved here at age 39 I didn't give a thought to the quality of the local medical care. Now that I'm 63, though, it's becoming a significant factor.

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  2. Before moving to Bend I looked into the level of medical care and determined that it was about on par, or better, than that I've been receiving in San Diego North County, and that St Chaz was better in some respects to Tri-City Hospital. I didn't come here thinking I was moving to medical care heaven. So I've not had a scales falling from my eyes experience.

    I don't get the feeling that his has been a trial and error process. An infection was detected, a culture taken, the infectious agents were determined and I was put on oral meds to slow them down while waiting for a bone scan, the bone scan indicated that the infection was getting down into the bone, surgery was immediately scheduled to dig in and clear out the crap, I've had a PICC line installed so the required antibiotics directly into my vena cava -- the way Real Men take their antibiotics-- and I'll be sent home with a home care IV setup to continue the treatment.

    It's a setback, but I'm not seeing idiocy.

    I've been involved in several lawsuits in the past, at the plaintiff and the defendant's ends. I know how those things can take over my life.

    The staff and care here at St Chaz for this procedure and recovery have been uniformly helpful and responsive. I've had plenty of other orthopedic procedures done over the past 30 years, some go brilliantly, some have complications.

    YMMV, of course.

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  3. "An infection was detected, a culture taken, the infectious agents were determined and I was put on oral meds to slow them down while waiting for a bone scan"

    I might have misunderstood, but the impression I got from your previous posts was that the oral antibiotics were (hopefully) supposed to knock out the infection, not just slow it down.

    "The staff and care here at St Chaz for this procedure and recovery have been uniformly helpful and responsive."

    Yes, I've noticed that about people in Bend. They may be incompetent, but they're really, really nice about it.

    I don't know about San Diego hospitals, but I do know that OHSU is regarded as one of the finest in the country. If I ever need major surgery that's where I'm going. I was very impressed by the quality of care they gave my mother-in-law, who had multiple serious medical problems.

    Hope things go a lot better for you from here on. You are a far, far more patient man than I ever have been or could be.

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  4. Yeah, sorry -- my poor writing, probably. After the culture was taken and the bugs identified I was put on orals and the scan ordered. Candida (yeast) infections are fairly uncommon and move very slowly, and they also respond slowly to treatment.

    The scan was done as quickly as possible -- one of the two isotopes used is short-lived thus not stocked and ordered on an as-needed basis. The scan indicated that the bone marrow was involved and the followup x-ray showed some erosion around the bolts so it was clear that more aggressive treatment was indicated. Thus the present course of action.

    Either way, if they had decided to open and clean right after the culture, or wait for the scan to show that the infection was not just superficial, this same course of action would have been taken.

    You don't want to open up a patient and pull out a screw and debride and scrape and deburr and pressure-wash and sand-blast and acid-etch and pack the screw hole with JB Weld unless you are darn sure that it needs to be done.

    I appreciate your concern! But I'm a fairly well-educated patient, and Mrs Elliott can smell a rat from a 100 meters.

    Other than that stupid unfortunate contamination (that it's a yeast has had plenty of medical folk here going "Huh?") we both think that the team are doing a bang-up job of doing what needs being done to clean up the mess.

    I've had far, far poorer care.

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  5. "Other than that stupid unfortunate contamination ... we both think that the team are doing a bang-up job of doing what needs being done to clean up the mess."

    Ah, but what I'm wondering about is why did the "stupid unfortunate contamination" HAPPEN? I wouldn't be too comforted by the fact that they were doing their damnedest to fix the mess they (possibly) created.

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  6. "I've had far, far poorer care."

    Is that called "damning with faint praise"?

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  7. "Ah, but what I'm wondering about is why did the `stupid unfortunate contamination' HAPPEN?"

    Of course. Everyone is wondering that. If a CIS style crime lab could examine the room, examine non-existent videos of the procedures, etc., etc., then there might be a chance of knowing what happened. No one likes infections, they are surgical nightmares.

    But infection does happen, and it did happen. I personally don't see the point of hammering on this issue any more. I've got plenty of stuff to deal with on my table right now and fretting over that error, that slip up (and I know I have committed thousands of errors myself) doesn't seem very productive.

    With regard to my saying that I've had worse care, it did sound like I was damning them with faint praise. I could have just as easily said that that this stay at the hospital was the best I've had. And it was.

    I'm well-pleased with the treatments I received, the care that I was given, the thoughtful way that everything was explained to me (until you've had a PICC line installed -- a fascinating yet creepy experience you have no idea how cool some of the tech is) and the people.

    In comparison, Mrs Elliott just returned here from L.A. and while she was there she visited her mother who was being treated for shingles in a very high-end Los Angeles hospital.

    Mrs Elliott stayed at my side here 70% of the time, sleeping on a recliner in the room, and found that dealing with the LA hospital to be hellish compared with this joint.

    We can compare statistics about how good various hospitals rate in terms of heart disease treatment, infectious disease tx, neonatal care, neurological disorders, cancer care, and so forth, and I would be surprised if St. Charles was in the top 10 in any of the categories. And for folks to whom things like that matter, moving into the neighborhood of the better-ranking hospitals may make sense.

    I knew I was looking at orthopedic procedures in my future before we moved here and Bend is fine in that regard, and Dr Askew is considered a very good foot/ankle man.

    So lacking any evidence of negligence (no shops have 0% cases of infection) or malice, this issue of trying to assign blame or fault is closed. I don't carry a grudge very well.

    On the other hand, if you'd like to personally take on the case and start an investigation, then more power to you, go for it; I'm not going to get worked up over it: I'm moving on, dealing with what's in front of me on a day-by-day basis.

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  8. "I personally don't see the point of hammering on this issue any more."

    Not for you personally, maybe ... but it is vitally important to the public interest if proper sanitary procedures are not being followed.

    "until you've had a PICC line installed -- a fascinating yet creepy experience you have no idea how cool some of the tech is"

    If it's okay with you, I'll just read about it.

    "We can compare statistics about how good various hospitals rate in terms of heart disease treatment, infectious disease tx, neonatal care, neurological disorders, cancer care, and so forth, and I would be surprised if St. Charles was in the top 10 in any of the categories."

    So would I.

    "And for folks to whom things like that matter, moving into the neighborhood of the better-ranking hospitals may make sense."

    To me, it matters. I couldn't care less about the bedside manner of the physicians or the friendliness of the smiles on the nurses. I want the best, most competent medical care I can get and I'll go where I can get it. If I want the amenities of a nice hotel I'll check into the Beverly Hilton.

    "I'm not going to get worked up over it: I'm moving on, dealing with what's in front of me on a day-by-day basis."

    That's fine; more power to you. I sincerely hope everything turns out okay. Now get better so I can buy you that drink!

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  9. "Now get better so I can buy you that drink!"

    That's what I'm talking about! All else is just games.

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  10. Alcohol applied internally in liberal quantities is a powerful antibiotic. The medical profession and pharmaceutical industry conspire to keep this a secret.

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  11. Sigh. I know, I know. But alcohol is a bad mix with certain painkillers and risky when one is as clumsy I am -- sober -- and happens to be nursing an ankle that has had one of two affixing bolts removed. One slip and hey presto! I've undone a lot of work.

    Patience, my friend, patience.

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  12. "But alcohol is a bad mix with certain painkillers"

    Ah, more medical propaganda! Many's the time I wouldn't have made it through the day without my favorite cocktail, the V&V (Vodka and Vicodin).

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  13. 'tain't the painkiller that has me off alcohol, 'tis the antibiotics. Neither fluconazole nor vancomycin get along at all with booze -- massive hangovers, crap side effects, majorly increased risk of liver damage.

    Dang it all.

    Choosing between a couple pints of ale and a two-hour IV drip of antibiotic should be an easy decision ... shouldn't it?

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