My Diabetic Foot Wound – Part 2

After the doctor called to inform me that I had MRSA, the supply place showed up with the Vancomycin.  I also found out that I was very anemic, but they decided not to do anything about that since I was not very active.  I was told my protein levels were low but I was never told how to fix those. Being anemic & having low protein levels can both hinder wound healing.

After being on the Vancomycin for six weeks, a second MRI was done.  I was told I still had an infection and was started on a second course of Vancomycin.  At the end of December shortly before finishing the second round of Vancomycin, I had another culture done and it came back with yet another infection – Serratia marcescens.  The beginning of January, 2006, I finished my second round of Vancomycin and had my third MRI.  At that time, I was told that the infection was gone. 

In February, 2006, I was starting to have alot of problems.  I was starting to get really sick again.  The VAC had slipped off one evening, and a home nurse that did not work with VACs much came in to change the dressing.  Two days later, the regularly scheduled nurse came in and discovered that the prior nurse did not put the protective coating on my foot, and my foot was macerated.   

That same week, I tripped and almost fell.  I was having alot of pain in my foot and just assumed it was from my foot being so macerated.  I later found out that I had actually broken my foot when I twisted my body to try and prevent myself from falling.

The doctor decided to schedule surgery to clean out the wound.  I was given a local and was awake for the debridement.  He told me that the bone in my foot was fine.   He planned on doing a culture at that time and had the nurse set out a culture kit, but he forgot to do it until after he had put something in my foot that would distort the results, so he was not able to do a culture. He said it didn’t matter because he was sure that I did not have an infection.  The surgery was on a Friday.  The following Wednesday, I saw him at the wound center and he then told me that my bone was soft. 

By then, I was pretty sick and decided I was going to see another doctor.  I could not understand how my bone could be fine on Friday and soft by Wednesday.  My sister knew someone that had taken her mother to a doctor in Pittsburgh for a similar problem – Pittsburgh was a three hour trip for us.  That woman was seeing doctors here for a wound and they wanted to amputate her leg – after going to Pittsburgh, she was able to save her leg.  My sister called them to get the name of the doctor. 

My sister is a nurse and she also called my nurse at the wound center to talk to her to find out the technical aspects of what was going on.  My sister was told by the nurse that I was assigned to that the MRI I had in January did show that I still had the infection, even though I had been told that the infection was gone and was not being treated for an infection.  They had also put the VAC on my foot and it should not have been put on with the osteomyelitis.

That same night, I was taken by ambulance to the hospital because I was so sick.  I was running a fever again and they decided to admit me.  The next day when the doctor came in to see me, he did a bone culture – he kept insisting that my foot was not infected.  I did not discuss with him that the nurse had told my sister the MRI in January showed I still had an infection.  I wanted to give him the benefit of the doubt and felt that because I had three MRIs, that maybe the nurse was looking at one of the earlier reports.

By the time the doctor came to my room, my sister had already called the doctor in Pittsburgh and made an appointment for Monday.  I had not been able to call myself since I was in the hospital & so sick.  I asked the doctor how long that I would be in the hospital – he told me a few weeks.  I told him that I had an appointment in Pittsburgh on Monday that I needed to go to.  I did not want to tell him why I was going to Pittsburgh, but he pushed the issue so I told him I was seeing another doctor.  He told me that I was not allowed to go because I had a hole in my foot (which he had been treating for 6 months at that point!) and if I wanted a second opinion, it had to be local.  He scheduled surgery for the following day.

After talking to my family, I decided that I was keeping the appointment in Pittsburgh and was not going to let them perform surgery the next day – I did not feel comfortable allowing someone that I no longer trusted to perform surgery.  That evening, another doctor showed up as my second opinion – a doctor that was chosen by the doctor that I was questioning.  I was also taken that evening for my fourth MRI and I found out my foot was broken and still had the infection in my bone, only now much worse than it had been.

The following morning, the doctor came into my room after he heard that I was not going to do the surgery.  He again told me that I was not allowed to go to Pittsburgh.  I told him that if I had to, I would check myself out of the hospital and that I was going to Pittsburgh on Monday.  I told him that I would stay until Sunday so that I could be on the antibiotics for the weekend.

Before I left the hospital on Sunday (and yes, I checked myself out), I asked the doctor that was there over the weekend about the bone culture that had been done earlier.  The culture had not made my chart yet, so he had to get it from the lab – I still had an infection in my bone.  He made sure that I had a copy to take with me and told me that the antibiotic that the other doctor had put me on was not the right antibiotic for that particular infection, so he prescribed a different antibiotic for me.

The hospital gave me the copies of my records from Wednesday to Sunday when I left on Sunday, but I still needed to get the ones from the wound center.  The next morning before leaving for Pittsburgh, we had to make a trip back to the hospital to get the rest of my records.

On the way to Pittsburgh on Monday, I started wondering if the infection I had at the end of December was the same as what I had in my bone (the culture in December was not of the bone).  When we got to Pittsburgh, we started going thru the records that I brought and I found out that both cultures were showing the same infection – Serratia marcescens and also a little Escherichia coli thrown in this time.

I met with a vascular surgeon in Pittsburgh.  He wanted me to come back the following week to the wound center that he participated in and wanted me to see one of the other doctors there.  He felt that I needed a team effort because of the severity of my wound.  He also told me to plan on being admitted to the hospital there when I came back and they would do surgery on my foot.  He said that unless they scraped the dead bone from my foot, my foot would not heal.  He also discussed with me the possibility of doing hyperbaric oxygen treatment because I had what he termed as chronic osteomyelitis.  I had brought my records, but not the films from the MRIs, and he wanted me to get those and bring them back the following week. 

The following week, I packed my bags and headed back to Pittsburgh.  I saw the vascular surgeon at the wound center, however, the other doctor that he had wanted me to see had already left (the doctors there were at the wound center for a few hours and maintained private practices).  The vascular surgeon did another bone culture and told me that my foot was mush.  He called the other doctor who said he would see me in the hospital.  I was admitted to the hospital from the wound center – that was March 7, 2006.

I posted some of the pictures of my wound on the pages section of my blog.  Those pictures were taken on Thanksgiving during this stage of the wound.  The picture with this post is from a different ulcer.  I didn’t want to totally gross people out by putting the ones that go with this story here.  If you want to look at the pictures, here is the link:

https://kellywpa.wordpress.com/diabetic-foot-wound-picture/

To be continued …

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