Wednesday, April 21, 2010

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.


  1. Great news!!! Is it weird if your blog makes me hungry? -otter

  2. I was seriously wondering how peanut butter would help an infection...good thing you clarified. My boys could have been running around the neighborhood with Jif lathered all over their knees! I am so thankful for the good news...see, prayer does work!! We love you. Yeah, i'm craving some pb&j too. Weird.

  3. WAY TO DOMINATE!!! It's all good news, even the peanut butter. Love Dad

  4. I know I'm going to sleep better tonight. Glad to see that Spunky is doing her job - giving you lots of love & affection. And she doesn't even care if your leg starts to smell again. She truly loves you unconditionally. Love Mom

  5. ohhh my goodness Tony.... what in the world!? ahhh, well prrraise the Lord the infection is going away, that is so scary. I feel bad, this is the first time i've hopped on your blog since the very beginning... I was cleaning out my mailbox and just found the email mom sent me with the URL. I've thought about you tho :) Will pray that infection goes away 150,000% and that you continue to feel better! lol, on the fellow crutcher story. Hi to Brooke for us! Luv y'all!
    Rebecca :)

  6. AmeriGel... F*** Yeah!

  7. Hi I had Ankle fusion surgery June 17 and ended up with Enterobacter infection. I have had four surgeries since the first and two abcesses on my shin a little bit higher than yours. I am really sick I had two surgeries last week one Tuesday night to remove the hardware from the ankle fusion (they don't think the infection will go away until the hardware comes out) and one Saturday morning to implant a bone cement rod with antibotics. Any advice? I am pulling my hair out :) I am on IV Rocephin for 8 weeks now. I was glad to happen across your blog (not that I want anyone else to go through this) but it was comforting in some way to see I wasn't alone. I am also hoping to snowboard again.

    1. I had a very similar experience to yours: Enterobacter infection, hardware removal and antibiotic rod, Nasty Rocephin. It sucked. You are now 3 years on. I hoped all turned out well for you.

  8. I had the same infection in my ankle surgery scar a few years back. It was ugly, but it did pass - Good Luck! Paul

  9. I destroyed (hockey accident) both the fibula and tibula with a compound commutated fracture of the distal head of the tibia.....21 screws, two plates, and four surgeries later I am getting ready for my 5th surgery to bone graft a tibial non-union. Currently have an external fixator holding it together as they removed all the hardware due to infection. BEWARE: I had the Enterobacter Cloacae bacterial infection, and Rocephin DID NOT KILL IT. 6 weeks with a pic line in and it adapted and became resistant to the antibiotic. I am now on Ertapenum, a really heavy duty antibiotic that seems to have killed it. I also have PMBB beads in there at the non-union at this time. Did any of you have to suffer the dreaded Vacuum sponge to close up the wound after plate removal? And yes, I hope to play competitive hockey again if my ankle flex allows.

  10. Unknown,

    I did had the wound vac 76 months ago in my fractured ankle due for ~1 week but due to a Psoudomonas Aeruginosa "terrorist cell" that choose to set up there. Very aggressive, it requiered the vac and home nurse visits to change the dressing daily. It was not that bad in terms of pain and discomfort, and it basically took care of the infection after 2 days (Dr. choose to let in a full week for reassurance and kepth in oral AB until harware was removed 3 months later). The vac was amazing in allowing an open wound heal quickier than otherwise, since my surgical cleaning took away some considerable amounts of soft tissue. No big deal then and so far no consequences after it. Carlos