My Diabetic Foot Wound – The End, Sort Of

I was admitted to the hospital in Pittsburgh on Tuesday, March 7, 2006.  The following day, the podiatrist (the doctor that the vascular surgeon wanted to see me), came in to talk to me.  After we talked and we went over the history of my wound and infection, he went to review my MRIs with the radiologist.  After he talked to the radiologist, he came back to talk to me again.  He called me a challenge and was not even sure what he would end up doing for the surgery until he opened my foot up.  Being called a challenge by the surgeon about to do surgery is not something you want to hear, especially when all the doctors coming in are talking about doing what they can to save my leg.  He wanted to schedule my surgery for Friday afternoon so that it would give him a couple days to think about what he would do.  He said that breaking your bone can cause swelling in the bone, and I also had the infection, so it was hard for him to tell what was because of the infection or what was from the broken bone until he opened my foot up.

Friday, March 10, 2006, was about the most terrifying day I ever had in my life.  When I was taken down to surgery, I did not know how much of my foot, if any, I would have left when I woke up.  That was the first question I asked the nurse in the recovery room and she of course would not answer my question, which only scared me even more!

The day after my surgery, the doctor came to my room to talk to me.  He had talked to my family after the surgery, but I did not get to talk to him until the following day.  He told me that my foot was a mess.   He ended up removing the bones in the center of my heel and left the outer bones as a shell.  He compared it to removing the engine, seats and everything from the inside of a car and only having the frame of a car left.  He told me that I would not be allowed to put any weight on my foot at all.  He had put some antibiotic beads in my foot and would remove those in a couple weeks.  He also said that after they were sure the infection was gone, he would put a bone substitute in my foot. 

On Monday, the infectious disease doctor came in to talk with me.  They had done another culture during surgery and the only thing growing in my foot at that point was a yeast infection.  They had put in another PICC line before my surgery and I was sent home on another round of Vancomycin.

When I arrived home late Monday afternoon, I was presented with a whole new set of challenges being in a wheelchair.  The first challenge being how to get in the house – my mother’s house had several steps at both the front and the back doors.  She had called the local ambulance company and several of the EMTs came to get me into the house.  I needed to figure out a way to get in and out of the house – we were in a small town and a small ambulance company, so if they were out on a run, there would be no one to help me.  Waiting to get back in would not be a problem, but getting out in order to get to appointments on time could be a problem.

A friend of my mothers volunteered her husband and his brother to build a ramp.  They came and measured everything and gave my mother a list of what they would need to build a ramp.  They were able to accomplish that before I had to get back out the following week for a doctor’s appointment.  They also widened the sidewalk and built a tiny mobile ramp to go from the sidewalk to the street.

You learn a new appreciation for being able to do things while you are in a wheelchair.  I wasn’t able to put any weight on my foot at all, so that meant not being able to reach for things that you need if they were more than arm’s length.  Although I was able to prepare my own meals, my mother had to put things that I used in places that I could get them.  Getting into the shower was also impossible – that was probably one of the hardest things for me.  I had two Yorkies and although they liked to sit on my lap, they didn’t like it when the wheelchair was moving.

The second surgery to remove the antibiotic beads was done March 31, 2006, as outpatient surgery.  That was a very simple, non-eventful surgery.

To add to the stress of everything going on with my foot, Nicky, my 14 year old Yorkie, had developed what I thought was an eye infection.  The vet said he had a ruptured eye and recommended removing his eye.  He had that surgery on March 30^th, the day before my surgery.  His heart stopped during surgery and he almost did not make it, but he did pull thru the surgery.  Because I was having surgery, my sister picked him up from the vets for me the day of my surgery.  About the time we got to the hospital, my sister got back to her house with Nicky.  I called her from the hospital before going down to surgery.  She said that he was not doing very well.  She put him in her dog’s cage to keep her son & dog away from him.  Nicky did not do very well and ended up dying on April 8^th. 

The third surgery for the bone graft was done two months later on May 31, 2006 – I was originally supposed to be admitted to the hospital after surgery, but did well enough during surgery to be allowed to go home that same day. 

In July, 2006, the last of my stitches from surgery were removed, but my foot was not closed yet.  Towards the end of July, I was having some extra drainage and my foot seemed swollen, so I made an appointment to see the doctor at the wound center (the week before, I had been given a reprieve to come back in two weeks instead of one).  He said my leg felt warm, so he did a culture, did some blood work and put me on an antibiotic.  When I returned the following week, they had the results of the culture back and I had another Staph infection – Staphylococcus intermedius.  

The decision was also made at that time for me to have the hyperbaric oxygen treatment.  After I saw the doctor, I then met with the clinical manager to go over the HBOT.  She reviewed everything with me and I was to call her the following day after they were able to check with my insurance company to see if that had to be pre-approved or not.

I called the clinical manager the next day and was given an appointment for the day after to go thru the screening process and meet with one of the medical doctors.  I would also start HBO that day, providing everything was in order medically.  Because I lived three hours away, she also helped me to find a place to stay so we would not have to drive back and forth every day.  The hospital owned an independent living apartment building for senior citizens.  Even though I was not a senior citizen, I was able to get an apartment there for the duration of HBO.  I was able to go down to the dining room for dinner and they had a computer for all the residents to use.  They took me to the wound center two days a week.  On the other days, the hospital had a van that they transported patients in so they took me back and forth on those days.

Everyone has asked me what it was like living with senior citizens.  I had my own apartment and was gone most of the day, but I did have dinner with them.  They had assigned tables for dinner and I was lucky to get with a good crew.  For the most part, they were pretty funny.  There was a living room with a big TV and they had a computer in there so I at least had computer access.  Hardly anyone else used it other than a guy from the assisted living building came over when theirs was broken – he said he liked to check Hotmail & the obituaries!  In the beginning, the HBO really zonked my energy.  When I first moved in there, some of the women invited me to play bingo with them after dinner & I told them I was too tired.  I used to go around saying I had a 90 year old body, but after living there, those people moved around better than I did!

Shortly after starting HBO, although I was not allowed to put weight on my heel, I was able to start walking using a walker and only putting weight on my toes.  After a little over 5 months in a wheelchair, that was a big relief!

I usually started HBO about 11 or so.  They always checked blood sugar, blood pressure & temperature before you went into the chamber & after you came out.  A doctor also had to check your ears before you went in & again when you came out because HBO can cause your ear drums to burst – I was lucky and did not have that problem!  I can’t remember which way was which, but it took a total of 17 minutes to get the oxygen levels to where they needed to be and then back to normal levels.  One way was 8 minutes & the other 9 but I don’t remember the order.  Once the oxygen was at the proper level, I was in the chamber for 90 minutes before they started adjusted it back to normal.  They kind of locked you in and once the door was locked, you were there for the duration.  There was a TV monitor on the outside of the chamber and you could watch TV or a movie.  Although the chambers were supposedly sound proof as far as outside sounds, sometimes you could hear people talking.  The techs were able to hear you if you needed anything and someone had to be in the room at all times when someone was in the chamber.  We each had our own water bottle and they would send you in with a drink.  After I came out of the chamber, one of the nurses would do the dressings on my foot. 

They wanted your blood sugar at 150 before sending you into the chamber so you wouldn’t have a low while you were in there.  That time of the morning was always hard for me to get my BS up and I would usually start eating glucose tablets while I was still in the waiting room to try & get my BS up. 

In October, the doctor put a couple stitches in my foot to try and force what was left of the wound shut. 

On November 3, 2006, I finished up a 12 week course of HBO.  When I finished HBO, my wound was not 100% closed, but was very superficial.  The doctor had given me a script to get orthotics – due to some delays with that, it was January until I received those.  They put an indentation in the heel under the wound area so I would be able to walk with my foot flat on the ground and not put pressure on the wound itself.  Between December and March, I only had to see the doctor once a month – a welcome relief after 20 months of either weekly or every other week trips to the doctor. 

At the end of December, I finally moved out of my mother’s house into my own place.  It was supposed to be a temporary stay and ended up lasting 18 months.  My sister & her husband were there when the movers brought my stuff in and helped get a couple things organized before they had to leave.  Unpacking when you couldn’t put weight on your foot wasn’t much fun!  I did a lot of crawling around because it was too hard carrying stuff. 

After I finished the HBO, I started seeing the doctor at his office because of scheduling.  He was only at the wound center one morning a week and with winter weather fast approaching, I needed more flexible scheduling.  When I was there in February, he was sick so I saw his partner.  His partner told me that he had assisted with my surgery.  When we were talking about that, he made a comment about using a new material.  Not too long after my surgery, my cousin told me that my brother told her that they were going to use cadaver bones in my foot – I verified that with my sister.  That really gave me the creeps and I did not want to know what was in my foot.  I figured as long as I didn’t know, I had a 50/50 chance of it being something other than cadaver bones so I never discussed that part of the surgery with the doctor.  When my doctor’s partner commented about the new material, I figured it wasn’t cadaver bones in my foot. 

I requested copies of my records from the hospital so I could find out what was in my foot.  I figured I should know in case I ever had problems.  When I got a copy of the surgical report, I found out that they used AlloMatrix.  AlloMatrix is made from cancellous bone chips (aka cadaver bones) and putty.  I never thought about something new still being cadaver bones.  By the time I found out for sure what it was, it had already been in my foot for a year so no longer bothers me.  I make jokes about the dead people in my foot now.

Early March, 2007, my wound was finally 100% closed, almost two full years after my ordeal started.

When I saw the doctor in March after my wound was finally closed, I asked him if I was allowed to use my treadmill.  That was one of the first things that popped into my head when he came into my hospital room the year before and discussed my surgery with me.  I was afraid to actually ask him at that time because I did not want to hear him say no.  Once my wound was closed, there was no reason not to ask.  He told me that I was allowed to use the treadmill, and the first thing I did the next morning was move my treadmill out of the corner & plug it in.  I started off with 10 minutes the first day and worked my way up to 60 minutes.  Although I am much slower than what I used to be because of the neuropathy, I am able to use it and that is all that matters.

I did everything that I was supposed to do; however, things spiraled out of control very fast.  Because I also have neuropathy, I didn’t get warning signals like normal people do.  I was lucky and had the resources and support system in place to allow me to travel to a larger city to get the treatment to save my leg.  I was also extremely lucky to find some really good doctors that did everything possible to save my leg.   I was on Vancomycin for 17 ½ weeks plus several weeks of the Unasyn before they discovered the MRSA and was also on several different oral antibiotics.  I had weekly trips to doctors, home nurses coming in, weekly blood work, several hospital stays, four surgeries, two PICC lines and a central line.  For 20 months, I saw a doctor for my foot alone either weekly or every other week and that did not count other specialists.  For 4 months, I saw the doctor for my foot monthly.  I did twelve weeks of HBOT, which required my staying in another city during that treatment because of the distance I would have to travel on a daily basis.  I was not allowed to put any weight on my foot after the surgery to remove the infected bone and had to use a wheelchair for over 5 months.  But there really was light at the end of the tunnel!

In case you are just starting to read this, pictures of my foot are at:

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

The title of this post was “The End, Sort Of.”  It is the end as far as the healing process and my wound being closed.  I am going to have one more section about the aftermath and what has happened with my foot since then.  Stay tuned!