Oh, That's Why I Need A Wound Vacuum

Brooke was at work today, so I got a chance at changing the dressing by myself.

A lot of my edema is gone now. It's kept under control with compression by an ace bandage during the day. I may have to wear a compression stocking on this leg for a year or so before I'm no longer at risk of edema build up.

Looks nasty, right? That's the thing with iodosorb ointment. It'll look worse than it really is until you scrape out all of it from the wound.

That's right. I had to bring my wound up close and scrape out brown dirt from my wound -- all without fainting and without a nurse. Because I'm not professionally trained, I may or may not have gone through 4 pairs of latex gloves. I still don't know how.

The wound is not getting better. It's getting worse. You can see how it's grown longer and wider. It's cutting down the line of my incision. You can also see how the skin around it is forming a slight depression -- kind of like a bowl. These are all signs the doctors saw yesterday that indicate the need for a wound vacuum.

Don't freak out, Mom and Dad. They said the tissue looks healthy inside. I'm back on Levaquin, so that will help fight of any would-be trouble making microorganisms.

Since we've been adding a ton of padding around the toe, this blister has finally had a chance to start healing. Unfortunately, I'm starting to feel the pain of this pressure ulcer. Heal fast before I get the feeling back!

This Is Going To Suck. No, I'm Serious. It Is.

My Dad sent me some decals to make my boot faster. It was pointed out to me later on that I put some of them on in the wrong direction.

Brooke and I just returned from The Closer's office. We received some mixed news. The good news was I can now put about 25% of my weight on my ankle while wearing my boot.

The bad news is my wound is a jerk.

I'm scheduled to undergo vacuum assisted closure therapy and to receive an allotransplantation. Since my last visit, the wound has grown in length and appears to be struggling to close up. It looks healthy, but it needs help.

In a few days, I'll be carrying a portable vacuum with a tube running down to the wound. A sponge will be stuffed into the wound and covered with polyurethane to create a seal. The vacuum creates negative pressure in the wound, sucking all of the tissue together and enabling it to heal much faster.

I found a picture online of what the portable vacuum system looks like. A purse.

I received an email to this article from two different people a few weeks ago. To Chris and Greg: please send me another email about what will happen to me a few weeks from now. I'd like to know when all of these complications will end.

After the vacuum treatment is complete, I'll receive a skin transplant. It's called an allograft. I think the grafts are usually donated by the deceased.

The reason I'm having problems with this wound is due to that underlying tendon. When I pull my foot up, that tendon applies pressure against the wound, preventing it from closing up. I was also told to cool my jets on some of my dorsiflexion exercises that use that tendon.

Finally, as a precaution, I'm going to be back on the same antibiotic for two weeks.

I'm looking forward to about 4 months from now.

A Co-Worker Told Me I'm Pale

Someone at work today said I looked pale. Everyone I work with is pale. I'm serious. Everyone. I really need some sun.

There's a slight possibility that I've crossed the line with my picture taking. It obviously annoys Brooke and my doctors.

I don't care.

When I have a son, who will be named Megatron, these pictures will help teach him a lesson about why you should always wear a helmet while snowboarding.

For the first time in a long time, there's not a whole lot that appears to be different between my ankles. I'm not sure if I've lost any of my tibia malleolus (the bumps on on the inside of your ankle). There's still quite a bit of swelling around that area.

My right leg looks like it's of normal size. It's a trick. It's still smaller than most 2-year-old's legs.

Like I've always said, I can heal with the best of them. The wound is doing great. It's definitely not 1.5 centimeters deep now. I'd say 0.3 cm now.

This is what iodosorb ointment looks like. Mud. We finally got some Monday. I'm not sure how this is clean or good for me. After about an hour, it feels like an extremely upset wasp is trapped in my wound.

We see The Closer tomorrow for my weight bearing evaluation. We had originally set this date last month before we found an infection. There's a chance that tomorrow I'll be permitted to put some weight on it for the first time since the accident. I won't be walking -- yet. I'll still be on the crutches, which I'm awesome at now.

Brooke and I decided that once I'm normal again, we'd buy some bikes and use that for my exercise. So to prepare for that, I bought a shirt on Ebay.

Don't be jealous.

I got another gift package from Egypt.


Jim thinks he's funny.

DC Is Out Of Peanut Butter

We found out yesterday that there isn't a pharmacy within 25 miles that has iodosorb ointment in stock. It won't be in until Monday at the earliest.

Without it, we couldn't do a dressing change for a few days. This morning, I woke up to some intense pain. I sleep in the boot, so I took my leg out to take a gander. Sure enough, I was bleeding out of the wound and through the tape.

I figured it was time to change the dressing. I called the doctor's office and they recommended we use America's gel.

Here's a look at the foot and ankle. You can see a lot of the swelling is gone. That's partly due to no more infection and a good tape job. I expect it will build back up.

I've developed a pressure ulcer on the bottom of the big toe because of the boot. It's not really getting any better, so I'm wearing a toe cap. All of the other toes are making fun of it.

The wound is still deep, but it's healed quite a bit since Wednesday. You can't see the tendon anymore. The opening is a lot bigger than before, but I think that was going to happen eventually. Brooke said it was good that it looked like ground beef. I don't think there was much beef in it on Wednesday.

There's my nurse wife, about to apply the American gel.

There's my pressure blister. It's disgusting. Hopefully the toe cap will allow it to get better.

Snowboarder vs. Enterobacter Cloacae

Above is a picture of Kate holding up the number one sign in support of a good outcome from our doctor's visit today. She's the latest addition to our good friends' family, Nick and Aubrey. And she totally saved my foot. Thanks, Kate!

Brooke and I both appreciate everyone's support! Thank you so much! We were confident that I'd dominate this infection. I'm known for killing bacteria. After examining the ankle last Saturday, we thought it was looking much better.

But we weren't sure what we'd hear today. Having an inch deep hole over your newly installed ankle hardware can be foreboding.

So who was the jerk that decided to remodel my shin and install a giant front door? A microorganism called enterobacter cloacae. There's a good chance I've had this infection since early March. Josie, my physician's assistant, said I looked like a cancer patient up until today. She wasn't the first person to say that, either.

According to eMedicine, "these ICU bugs cause significant morbidity and mortality, and infection management is complicated by resistance to multiple antibiotics." In other words, this species doesn't mess around.

Fortunately, Levaquin is one of a few antibiotics that can destroy this bacteria. Owned by modern medicine.

This is where you belong, enterobacter cloacae. In a petri dish. Not my ankle.

One of my fears going in this morning was that removing the iodoform from the wound would be painful. I also thought massive amounts of bleeding would ensue, like last time. So, of course, we took a video of Josie removing the iodoform to capture that moment.

It was the most anticlimactic wound stuffing removal ever. I was in my usual professional form by referring to the stuff inside the wound as "goo."

We had a team of three physicians evaluating the front door in my shin. Everyone agreed that the ankle looked great and that the infection was getting its butt kicked.

The wound did not appear to be as deep as it was last week. It wasn't draining and there was no swelling around the ankle. The infection, fortunately, was only superficial and stayed away from the two plates and nineteen screws.

See that white thing? That's a tendon! How awesome is that? It was the first time I've ever seen a human tendon. It was both extremely creepy and amazing to see it move as I moved my foot.

The bad news is I've got about a month of daily wound dressings. I also don't get to wash my leg anymore in the shower. I'm looking forward to the smell.

Instead of stuffing the wound with iodoform, we now use peanut butter. Creamy peanut butter. You think I'm joking, but I am not. I have peanut butter stuffed inside of this wound right now.

Okay, I lied. It isn't peanut butter. It's called iodosorb ointment.

It's basically iodine. When applied to the wound, iodosorb cleans it by absorbing fluids, removing exudate, pus and debris and forming a gel over the wound surface. As the ointment swells, iodine is released, killing bacteria in the wound and making the owner of the wound suffer a nice stinging sensation.

In addition to the peanut butter, we get to use something called AmeriGel on the scar around the wound. I just thought it was awesome that the gel was named after America.

The best news we received today was that I can continue my physical therapy homework. While I have to wait another month before seeing my physical therapist again, I at least get to keep working at the ankle at home.

So hopefully this is the last bump in the recovery road. The last two months have been tiring at times.

Spunky wasn't concerned about the wound. Now, neither am I.

The Day Before You Find Out

Tomorrow I find out what the next few weeks will look like.

1. The drugs worked. Wait a month for the wound to heal before starting physical therapy.
2. The drugs didn't work. Here are new ones.
   
3. The drugs didn't work. You have MRSA. Check into a hospital and get IV antibiotics.
4. The drugs didn't work. Check into a hospital and have a surgery to clean out the infection.
   
5. The drugs didn't work. You have infected hardware. Check into a hospital and get new hardware. Re-experience the last two months. Maybe start a blog.
   
6. The drugs didn't work. Give us your foot. It's no longer useful to you.

I'm really hoping for option one. The rest of them aren't as fun. But let's say I do lose my foot. That means, I'm guessing, that I get to skip a lot of my physical therapy.

So while I wait, I thought I'd post videos of my original CT scans, just hours after I hit a tree on a snowboard.

What Day Is It?

I went to bed Thursday night and, for the most part, slept through Friday. My body was exhausted. The only times I woke up Friday were to eat. I couldn't believe how hungry I was when I woke up each time. I ate a ton of food.

Hopefully these are all good signs that my body is busy dominating the bacteria in my ankle. My ankle is more sore than normal, but a Capitals win tonight in overtime helped with the pain.

Tonight we had to change the dressings on the wound. We're basically wound dressing professionals now.

Looks like we had some leakage. I honestly didn't get a chance to see what the wound looked like before they dressed it with the iodoform stuffed inside.

Here's what it looks like to have a bunch of antiseptic yarn stuffed inside of your shin. To be honest, my ankle looks really good. I'm no doctor, but the discoloration seems to be dissipating. Pulling the gauze off of the wound felt amazing.

I finally got out in the sun Thursday afternoon. I apparently need about a dozen more outings to look normal again.

Snowboarder vs. Bacteria

When I saw my physical therapist two weeks ago, she was concerned that I might have an infection. Because I had seen my doctor a few days earlier, and my leg and ankle looked the same, we just decided to monitor it for any changes.

Well, I finally noticed a change. Turns out, it was a big one.

On Monday morning, I noticed some new discoloration on the right side of my foot. Last night, I noticed a bump underneath one of my steri-strips on my top incision. I decided to break the rules, again, and remove the steri-strip.

This is what I found hiding underneath. Yep, time to call the doctor.

I called early this morning and got an appointment. Dr. Buchanan's physician assistant, Josie, was not happy with me on the phone. When I described my symptoms, and let it slip that my physical therapist told me I might have an infection two weeks ago, I got yelled at.

So what is this a picture of? I thought it might have been a surface blister. We discovered that it is in fact a very deep and infected wound. They stuck a q-tip inside. How far down did they go?

1.5 centimeters. According to Yahoo! answers, it's about as deep as a peanut M&M.

That's almost deep enough to hit bone, but not quite. That's a good thing. We're really hoping the infection hasn't hit the bone.

I was also told it's very good that I have a lot of soft tissue around the wound. All of that meat gets to absorb and divert the infection away from my bones. Unfortunately, since I have a ton of hardware in the ankle, this infection is serious business.

So what now?

They took cultures inside of the wound and Brooke is currently running them over to a lab. Yet again, she's proving how awesome she is. She has a ton of homework to do, and almost all of her day has been spent on my stupid injury.

When we get the results back, we'll know if the antibiotic I'm on covers it. I was prescribed a powerful antibiotic called Levoquin. It's used to treat severe bacterial infections, so it's a big gun. I am, however, at a slightly higher risk of it being MRSA since Brooke works at a hospital.

Let's just go ahead right now and say it isn't MRSA. That's nothing to mess around with.

The picture above was taken after I was probed. You can't tell how deep the wound is, but it was enough to make me go pale when I saw how far the q-tip went in.

I asked about my risk for another surgery. There's less than a 50% I'll need one, but we won't know for sure for several days. I go in again on Wednesday to see how my immune system is performing.

They stuffed the wound full of this antibiotic string. I think they did that only to make me feel uncomfortable. Now I can't do any physical therapy and I need to rest my leg for a few days.

Look, here's the deal. I'm going to dominate this infection. If I need surgery, then so be it. But no small, microbial bacteria will prevent me from snowboarding again.

Just as I was leaving, Josie told me I really needed to get some sun. Am I really that pale? That's the second person to tell me that in one week.

Dippy Bird and Those Stupid Eyes

I have no idea why this happens, but I've been pranked at work on numerous occasions. Here's the short list:

• All of my important and timeless books were stolen and replaced with Windows 95 books and other manuals from 1986. For those of you that aren't computer scientists, this is an insult above all insults.
  
• My book shelves have doors. One day, when I opened them, I found myself in a substantial pile of packaging peanuts. Apparently, the thieves wanted to return them in such a way as to avoid breaking them.
  
• One time, I won a prize at a picnic. It was a Nerf gun. Days later, my darts were stolen. When I complained, they were returned, but my gun went missing. It was returned to me yesterday after about a year.
  

When I got back to my cubicle yesterday, my chair was gone. My name plate had been replaced with, "Sir Dippy Bird." There was newspaper covering my entire desk. And where my keyboards used to sit, there was bird seed, a partially eaten gummy worm, and a perpetual motion bird.

This was my replacement. Apparently this bird has done more work in the eight weeks I've been absent than I've done in my entire life. Everyone that came by to see me this week first asked how Dippy Bird was doing. They were all so impressed by how much of a better job he was doing.

There was even a picture of him on his desk with Run-DMC.

Needless to say, I don't get along with Dippy Bird. Has Dippy Bird ever had to massage fluid out of his gimp foot? No way. Ever wondered what it looks like to massage fluid out of a gimp foot? I thought you might!

Here it is. A classic fluid lump on the top of my foot. I took this picture last Sunday after being up on it all day. In theory, I'm supposed to push that gross pile of fluid all the way up to my knee.

Fact: Superman couldn't push that lump past my knee.

The good news is my fluid build up wasn't too bad Monday or today. I've done a good job of keeping my foot elevated.

I also took this photo on Sunday.

This was taken just a few minutes ago. It looks better, right? It's a bit smaller. Hopefully it has finally decided to heal.

The February 13th incision is just about done healing. That just goes to show you how brutal these injuries can be. Since there's no muscle around the bone explosion site, my skin absorbed most of the energy. The resulting swelling, infection, and necrosis really slowed the healing process.

It still needs to be treated like an open wound, but probably only for a few more days. It's funny to think that just a month ago, I was freaking out that this part of my leg was going to die.

This was what it looked like four weeks ago. That's a gigantic difference. Good work, body. Good work. It's about time you did something around here.

I cheated and removed one of the steri-strips myself. I'm supposed to wait for them to fall off on their own. I don't know why I've been leaving them on. The incision has completely healed. There's nothing for them to hold together anymore.

It's probably another prank.

Broken Ankle Brothers

Today I met a fellow fib-tib ankle fracture survivor. Unbelievably, he works in the same office as I do. I had heard there was a dude crutching around in a boot several weeks ago. I had no idea what his injury was.

In November, he fell off some scaffolding and received a nice open compound fibula and tibia fracture in his right ankle. Yep, his bones were sticking out. Mine where nicely contained within my skin. He didn't have a pulse in his foot after the injury, so he too was at risk of losing a limb.

It gets worse.

He broke his talus bone in three places, he had three surgeries, and he was in an external fixator for seven weeks. One of his surgeries was necessary to remove two infections. Because of this complication, they never had a chance to fix his talus fracture. The fragments set further apart. His talus bone is now larger than before the accident.

There were only two things I could think of about his injury that was not as bad as mine: 1) he didn't have 3 million bone fragments at the surface of his ankle joint, and 2) he didn't have any nerve damage.

Many of our experiences with this injury have been identical. In an odd way, it was pretty awesome to meet someone else that's suffered a similarly amazing injury. It was like I was looking into the future a few months from now.

Oh, and both of us agreed that our favorite dinosaur was the Velociraptor.

First Day Back to Work

Fact: no reasonable human on earth should wake up at or before 5 AM. It is the most ridiculous time to be awake. That was my only problem throughout the day. I was tired.

I had unfortunately adopted the college student sleeping schedule over the last eight weeks. It made me look even worse than I normally do. I'm already more pale than the most computer scientists. Now I am more tired than most computer scientists.

I was very happy to see everyone at work. My new nick name is Eileen. They gave me this name when they discovered I had lost about 2 inches in my right leg before my first surgery.

It's good to be back full time, but it's going to take me some time to get back into work shape. My brain, just like my calf, has atrophied. The most stimulation my brain got during my injury was from an episode of Seinfeld.

When I got home today, an elevator in the metro station was out of service. It was my only way to get across the tracks to the street elevator. It must have happened while I was at work, because all of the elevators were in service this morning.

Without any means of escaping the station safely, it was my golden opportunity to try my hand at riding an escalator. Mom, Dad, and Brooke -- don't worry, I didn't fall very far.

As I was getting on the street elevator, another gentleman was inside about to enter the station. He too was on crutches. As soon as I saw the bottom of the crutches, words queued up in my brain and started their journey to my mouth. Like the idiot I am, I wanted to be friendly and say something to him. I felt like we each belonged to a crutch brotherhood.

But as I looked up, I saw that they were the more permanent kind that conform to your arm. He didn't have any broken legs. My brain immediately sent an emergency stop signal to my mouth. It was too late. I heard myself utter the words, "I feel your pain."

Seriously?

That is probably the worst thing I could have said to him. I had just verbally snowboarded into the tree of social awkwardness. I imagine most of my friends will say this is par for course. He immediately responded, "yeah, but I've been doing this for 35 years. I'm in much better condition than you."

He was absolutely right.

The Inaugural Injured Tony Award

Congratulations to Alison Stailey for dominating the injured Tony visitation competition, proving she's a better friend than Ken Schwerd, Andy Row, and especially Sean Shadid (who thinks he deserves a thank you card for texting me).

Alison has gone above and beyond the duty of a friend. Not only did she drop by to say hello on more occasions than anyone else, she also ran both Brooke and Spunky. She is most deserving of this coveted trophy. However, she probably didn't deserve a picture of me and my blood blistered toes on the Internet.

As you can see, the trophy is extremely shiny and sparkles day and night. You can also see I'm low on water in my water jug and that I need to throw away a cardboard box.

Of course, the award is only for the 2009 - 2010 season. Much to my parents' and wife's dismay, I plan on continuing to snowboard at the expert level as long as possible.

There's always that chance we'll need a new trophy for a new season. I just need to figure out if it's better to re-injury the right ankle or to try for the left next time.

Finally, for those of you surprised that I made a custom trophy for my stupid injury, this isn't my first trophy rodeo. I live nearby a trophy shop. I think this is the seventh trophy I've made so far.

More Gifts from Egypt

I'm hoping to get another gift from a friend of mine in Egypt. By now you should be familiar with Jim's gifts. He sent me a bell to ring to get Brooke's attention as well as a beginners crochet set.

No yarn, though.

He sent me this photo this morning. It's a perfume store called Ketchup. It's next to the Red Sea, but I believe that only affords them about a 10% justification for the ridiculous name.

April 8th Flexibility

This is how far I can move my ankle as of April 8th. I'll upload a new video every week and hopefully I'll notice some improvement.

Ankle Update

Believe it or not, I didn't faint after taking this picture. I can remove my wound dressings without going pale. It's probably because my top incision is covered and the wounds on each side of my ankle look a little better each day.

Much of the edema in my foot is gone now. However, you can still see it in my ankle. That's why it's so lumpy. At least, I'm hoping that's why it's so lumpy. Could you imagine if this is what my ankle looks like now?

My toe bruise is getting better. My ankle does not bend upward beyond 90 degrees, so when I'm in my boot, there's a lot of pressure on this part of my foot. Hence, the bruise. As my flexibility increases, this pressure should go away. But it's still there. It usually hurts the worst at night.

The wounds on the right part of my ankle are almost gone. I think all of the swelling and edema, as well as these two wounds, will make my scar look gnarly in a few more weeks. It's hard to see it now with all of the fluid.

It's April 9th. I had my second surgery on March 1st. That's six weeks. What is this thing?

Heal already!

I poked this red thing with a q-tip and it's some kind of fatty tissue sticking out of a hole. You can plainly see that the two holes above it healed just fine. But for some reason, this guy wants to hang around.

Check out the bottom of my heel. The darker skin is all dead. Gross.

When I'm done washing my leg and cleaning the wounds, I had to cover it back up with this orthopaedic sock. I was reusing the same one each time. I thought that was nasty, so I went online and bought more.

Twenty five yards more.

That might have been a bit much, but I plan on snowboarding for several years. I'll just keep it for next time.

Planning Ahead

Brooke and I went for a walk outside tonight. The plan was to walk to a nearby metro station and ride back. I'd get some more crutch exercise as well as experience riding the metro as a disabled person.

That was about the extent of our planning. We didn't look online to see if there were any elevator outages. Turns out, there was an elevator outage at our destination. The crutch back was basically all uphill.

I opted for the $3 cab ride back.

Lesson Learned

Today I was talking to Brooke about the 2011 snowboarding season. I plan on being there. I plan on snowboarding. But I need to learn from my mistakes. Next time I see a tree, I'll just jump through it.