Saturday, September 5, 2009

Can you feel the adrenalin rush? Can you sense the crescendo of "survival" fever kicking in? That's where I am. I am getting fired up to start climbing out a a valley that I hadn't seen coming. Rock on, dudes!

On Monday, we learned that my ankle is in sad shape. We knew it was sad--but now it is downright depressed. The dark space by Area B shows where there is cartilage still on my talus. You can see that there is no dark space on Area A--indicating that the bone is resting right on bone. Not good for a moving part carrying all of your body weight. Area C and D shows the top of my talus--the part that I shattered. Area C died a long time ago--you can tell because the area is not white--it is gray. The bummer thing is that in the last two months, Area D has become gray. This either means that it is infected or dead. Without C & D, my ankle will not work.

On Thursday, Dr. Jacobsen pretty much confirmed everything that Dr. Carbonell was suspecting. He took one look at my ankle and said that it looks exactly like something that is fighting a deep bone infection. He was thrilled to see how much my wound had closed up, but was clear in communicating that wound closure is not the problem anymore--it is a symptom of a much bigger problem. Worrying about VAC machines, dermagraft, skin grafts, and pig intestine is now a thing of the past. We now have to figure out how we are going to "save" my foot.

When I first fell, a lot of dirt and debris was mixed up in between the fragments of my talus. I had three surgeries just to try and remove the debris, and to put the talus back together. After that, I was on very heavy IV antibiotics for five months in order to kill the bacteria that was lingering behind. We thought we had beat it, but it is obvious now that some bacteria is still inside my ankle. I would love to just ignore it and pretend that it isn't there, but we MUST remove the bacteria or it will eventually kill off everything in my ankle.

Don't worry--the infection isn't going to race up my leg and kill me--it is a slow process. But just like we have seen with trying to close my wound--nothing in my foot can do what it is supposed to do when it is fighting bacteria at the same time.

Although my news wasn't great, I left feeling that I am in--and have been in--REALLY good hands. When Dr. Carbonell told me of his suspicions on Monday, I thought, "Oh man, we waited too long. I should have known this would happen. I probably should have gone back to Dr. Jacobsen a long time ago . . ." Yada, yada, yada. But, Dr. Jacobsen was so reassuring in letting me know that we would not have known this without the passage of time.

So . . .

Phase 1: Have surgery soon. Back out the screws that are holding in the metal plate (the one shown in this picture), and scrape the holes that are left behind to remove any infected bone. Dr. C will also probe all around my talus to find bone that is infected or dead (we already know that there is plenty). Even though I would like for him to hack away, both Dr. C and Dr. J say that it is best to be conservative in removing bone around the talus. They would rather leave some dead bone behind (dead doesn't necessary mean infected), than to cut out so much that my ankle can not function properly anymore. Dr. Carbonell will also take multiple biopsies of the bone to test it later.

Phase 2: Kill me with antibiotics. Dr. Jacobsen would like for me to start back up on my heavy-duty IV antibiotics the day after surgery. I will take them for six weeks (that's what they always say--haha!--47 weeks later . . .). This will be the wait-and-see time. Wait and see if the wound starts to close up. Wait and see if I am running fevers. Wait and see if green gooky stuff is coming out of my leg.

Phase 3: If Phase 2 goes well, we will wait some more and see what happens when I am off the antibiotics. If Phase 2 does not go well, I will go back in for more surgeries to remove more bone and take more biopsies.

REALITY: Even though the doctors talk about trying to save the talus, I know in my heart that I will eventually have my ankle fused in a permanent position. Whether it happens now or in two years, I know that I can not possibly walk on dead bone with no cartilage. So--even though my doctors might be disappointed if they have to cut away so much bone that the talus is useless--I am cool with it.

I am just happy that I have doctors who are willing to stick with me through the "long haul." Even though I am ready to chop of my foot and call it done, they are firm in insisting that we take it slow and conservative.

I have read an awful lot of blogs written by people with ankle problems who have also begged their doctors to pull out a chain saw and chop off their feet. However, when they finally have had to go through the long, painful, and complication-prone process of having a fusion, they are grateful that their doctors forced them to exhaust every foot-saving possibility before "giving up."

For some strange reason, I am feeling OK. I am changing my mental picture and realizing that we are not going to be free of Anne & Ankle for a few years. I am going to do my best to continue on without "trauma drama" and just plug away quietly. It has been incredibly wonderful to be back in the classroom teaching. (I DO NOT EVER want to be on disability again. That is why I really have to be careful with those killer antibiotics.)

Annika and Elise are soooo happy. They love their friends and teachers. They enjoy being at school and helping out wherever they can. They have really come alive as things have seemed more settled. This is why I hate having to stir the pot again.

My heart goes out to Doug. These setbacks really take a toll on his spirit. His dear Dad had a big surgery two weeks ago to repair two of his heart valves. Dad Heetderks was recovering beautifully until last night when we found out that he developed pneumonia. We know that he is strong and will recover, it is just hard to be so far away. Worrying about me--and now his Dad--has been hard.

Thanks for reading this novel and sticking with me throughout this journey. Your notes of encouragement and sympathy are always a boost! Love to you all!

Anne

Monday, August 31, 2009

Well, my friends . . . I got thrown a little curve ball today. Thought I better share . . .

Since I last wrote, I have been LOVING school, and working on walking with my boot. I am hooked up to my VAC again so my students have the pleasure of watching my body juices slowly move through the tube as I teach my lessons. The VAC also makes intermittent fart-like noises that are always appreciated by my amazingly mature students. :)

Last week at Wound Care, I expressed that I was still feeling a lot of pain when I tried to walk. So, Dr. Carbonell asked that I come to his office to get an injection of some stuff that would bring down the swelling around my ankle--and hopefully make walking less scream-out-loud-painful. Not only did I end up getting the shot, but Dr. Carbonell assessed that most of my pain was being caused by tendonitis. Therefore, he fit me for a brace, told me to try to flex my ankle a little more to start building strength in the muscles and tendons, and set me up to start physical therapy.

My students were SO excited to see me wearing a regular shoe and "walking" with a walker on Thursday morning. I almost felt like this was the beginning of the end . . . My wound was humming along on the VAC and I was flexing my ankle in a "walking" motion. I could almost see my wound being closed and walking with a cane by Christmas.

Insert here: curve ball.

On Friday night, I was practically crying out loud at the excruciating pain in my Achilles. Forget about the brace--I was moving back to my stable, non-flexing boot.

On Saturday morning, I noticed that my VAC tube was full of greenish looking mucus. Sure enough, when I went to change my dressing on Saturday night, it was OBVIOUSLY infected again.

I called Dr. Carbonell on Sunday morning and he called in a prescription for more antibiotics and told me to come in first thing on Monday morning.

Well, here is what we found out.

We now believe that there is a deep infection in the bone. Despite 5 months of major IV antibiotic treatments, the original infection was probably never killed from inside the bone. Although we kept it at bay for a while, it is coming back over and over now and using my wound as a drainage spot. This would most likely explain why my wound has not healed.

The x-ray taken today also shows a large area on my talus bone that is gray rather than bone-white. The gray area either indicates bone death or infection. We knew that the bone had died in some areas, but that should have stopped at the 6-month point. The fact that the gray area has grown significantly in the last 2 months seems to be another indicator of bone infection.

So . . . I am going back to my infectious disease doctor (good 'ol Dr. Jacobsen) on Thursday. He and Dr. Carbonell will discuss how to proceed then. Most likely, I will be going back on long-term IV antibiotics (PICC line in the arm, balls of antibiotics in the refrigerator, injecting myself every 8 hours) and having surgery to take multiple bone biopsies. If the bone is indeed infected, they will either try to treat the bone to kill the infection, or start removing the bad bone. If they have to take away too much, the ankle will be basically useless and will have to be fused.

Basically, rather than seeing the light at the end of the tunnel, I am now a ways back at the entrance.

I feel a bit like I have been hit in the gut. I had a moment or two this afternoon where I felt like I was drowning in the whole situation. I can not STAND to see the sick look on Doug's face when he finds out stuff like this. I hate to do this to him again.

However, on the whole--I feel like it makes good sense. It is do-able. It is not going to kill me. I am in good hands. We will make it. No freaking out is necessary. God has a plan (He always does).

The End.

P.S. I will write you to tell you what happens on Thursday with Dr. Jacobsen. That appointment will be VERY interesting.