Friday, September 23, 2011

Looking for Some Breaks to Catch -- Got Any?

Ladies and gentlemen, uhhh, this is your Tree-Hitting Snowboarder speaking. Please, uhhh, return to your seats and fasten your seat belts. Remain calm. There is absolutely nothing to, uhhh, worry about. This is just standard operating procedure. Our systems indicate that, what we refer to as a rough patch, is heading right for us, and, uhhh, there's a slight chance our ankle recovery could crash and burn spectacularly. Thank you.

This was one of those blog posts where I had to call Mom and Dad first to help manage some expectations. Otherwise, the phone line would be busy until the cows come home.

Before we go any further, there's no need for you to freak out.

Well, not yet.

Here, just let me quickly summarize what you're about to read: the first act will be scary, the second act will be scary but optimistic, and the third act will leave you hanging until the sequel comes out.

Like some sequels, it could be totally awesome -- perfect example: The Dark Knight.

But, like other sequels, it could be absolutely awful -- see Speed 2: Cruise Control.

Yes. This movie actually exists. This is probably the first time you've heard about it. It was that bad. Or, at least, so I've heard.

Act One

Today I stayed home from work to wait for a repair guy to fix a minor leak in our air conditioner. Since my accident, I've always payed careful attention to how much annual and sick leave I use. Each hour I use is a serious decision.

After the technician did an excellent job fixing the small leak (thank you, Fry Plumbing), I decided to change my dressing several days early. Due to some new pain, I wanted to get a good look at a few troublesome pin sites. The pain is not unbearable, but after a long day of walking on pins (no needles), I have to resort to my pain management medication. Moreover, I can no longer walk without crutches due to the pain.

These are significant changes in a matter of a few days. That's usually not a good sign.

Unfortunately, removing the dressing revealed drainage in two k-wires in the top of my tibia on the medial side (the inner side of my leg).

Drainage from a pin site can mean many things. It could be from agitation from pin movement or skin movement around the pin, it could be fluid build-up from the initial trauma of the surgery six weeks ago, or -- in a worst case scenario -- the fluid could indicate an infection.

The drainage was very minimal, but as I poked around the skin, it felt like a water bed underneath my skin. It was time to use some skills I picked up as a teenager and play, "Pop That Zit." As you can see in the picture above, a small amount of warm, sticky yogurt oozed out of the pin site.
This is your Tree-Hitting Snowboarder again, reminding you that, uhhh, we've conveniently placed barf bags in the seat pocket in front of you.
I'll give you a few moments. When I squeezed that bad boy, I had to take a few minutes myself to recover. Two years ago, I would have fainted after getting my blood drawn. Now, I'm pushing bodily fluids out of metal wires sticking through my tibia, muscle, and skin on both sides of my leg.

Back to the yogurt. As an experienced external fixator wearer, pin site yogurt is a red flag. Immediate action is necessary: continued squeezing and popping to see what other items emerge from the pin site.

I'm was hoping for something awesome and better than pin site yogurt. As you are probably well aware, pin site yogurt serves no purpose in life. I can't sell it on eBay and I can't trade it to replace Arian Foster on my fantasy football roster.

After more squeezing, not much more fluid came out. Without Brooke at home, I quickly assembled an action plan. I decided to examine all of my pin sites, take high quality pictures of questionable areas, and contact my surgeon, Dr. Jeng.

Here are several pictures of the same pin site on the medial side of my leg.

After thoroughly documenting this pin site, I noticed that the most proximal k-wire on the medial side was also oozing the same type of fluid -- without any application of my super zit popping techniques.

The skin around both pin sites looks good -- the oozing, along with the pain while bearing weight, appear to be the only two symptoms at the moment.

Both k-wires on the lateral side of my leg seemed fine. There was a bit of redness around the most proximal k-wire, but no yogurt.

Act Two

After taking pictures and uploading them to a Picasa Web Album, I called up Dr. Jeng's surgical coordinator, Denise, to let her know about the new pin site drainage. Because it was so late on Friday, I was expecting I'd have to leave a message and wait until Monday to hear back -- if I was lucky.

But that's not what happened at all. Denise quickly tracked down Dr. Jeng in the office and we spoke on the phone for a while. This was late in the day -- around 4:30PM -- and here's Dr. Jeng taking time out of his busy schedule to discuss my concern.

This is the type of doctor all others should emulate.

Dr. Jeng asked me to email him my web album to his personal email address so he could take a look. He insisted the pictures be taken with a high resolution camera with adequate lighting. He also instructed me to stop bearing weight and to stop moving the ankle.

While I waited for Dr. Jeng to review the images, I tried my best to ward off the Eeyore mood. Sometimes a good mood just comes to you naturally, and sometimes you've got to force it. Either way, bad attitudes can be detrimental to a recovery.

But the Eeyore thoughts were racing through my head. I could live with a pin site infection anywhere on my foot -- but a pin site infection in the same part of my tibia where a future amputation will take place is bone chillingly frightening.

That part of my leg needs to be pristine.

I eventually kicked Eeyore's tail out of my head when I realized how lucky I was to have taken the day off. If I hadn't, I would never have caught Dr. Jeng on the phone. And, how awesome was it that Dr. Jeng was willing to take time away from the end of his work week to work with me over the Internet?

Pay attention, doctors -- this is the right way to do things.

Act Three

Dr. Jeng called me a few hours later after reviewing the pictures. He said he was encouraged that the skin around the pin sites did not, "look angry." He asked if I had taken a shower with it yet. I had not.

Dr. Jeng really did not want us to put the pin sites under running water due to a study his old roommate did on shower head bacteria.

He asked if the pin sites and pain had improved since we started the Duricef on Tuesday, and I replied that it had either stayed the same or had gotten worse.

Dr. Jeng told me that, fortunately, k-wires are extremely easy to replace in case this ends up being an infection. He reminded me that I should have enough antibiotics left to last me until the beginning of next week.

Being the awesome surgeon that he is, Dr. Jeng wants to see daily updates. I'll have to take photos and videos of the pin sites so he can track the progress over the weekend.

That's the kind of care, concern, and professionalism that inspires awe.

Dr. Jeng is awesome.

So, stay tuned for the sequel. We'll keep tracking the pin sites and work with Dr. Jeng this weekend to see if we notice any improvements. In the meantime, I'm no longer bearing weight and I'm no longer moving my ankle. While this will slow down any cartilage growth opportunities, it's worth the sacrifice to prevent an infection in this part of my tibia.

One of my good friends told me today that I just can't seem to catch a break. If anyone's got one, please email it over or fax it. I need a couple. And while this might be bad news, it's helped show us that we've picked the right surgeon.

It takes a special person to work with someone as annoying as me over the weekend during college and professional football season.

Maybe Dr. Jeng is willing to give up Adrian Peterson for some yogurt.

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