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. If you want to look at the pictures, here is the link:

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

To be continued …

My Diabetic Foot Wound - the Beginning

One of the reasons for starting this blog in the first place was to write about what happened with my foot - two months later, I am finally starting to do that! Because this was a two year ordeal (more like nightmare!), I thought it would be better if I break it up into sections.

Like a lot of other people, I learned the hard way the importance of checking your feet every day. My first ulcer was a huge hole in my foot that I don’t know for sure what caused it. I discovered it on a Friday morning while getting ready for work. The day before, I had been at a client’s office that had a gravel parking lot and my first thought was that a stone came thru my shoe. I looked at the shoes I had worn the day before and although there was blood, there was no hole coming thru the bottom of the shoe. I then looked at all the shoes I had worn that week. Monday evening, I had gone to a party at my cousin’s house and wore some sandals I rarely wore - they also had blood on so I knew that it had happened before Monday evening.

The weekend before, I had been outside with my dog Nicky without shoes on. I would always just stand on my deck and wait for him. That weekend, my neighbor was also outside so Nicky had to go pay a visit - she had two Yorkies so I guess he knew she was a Yorkie lover also. I walked in the grass without my shoes on so it is possible I stepped on something that day. Nicky liked to chew on cow hooves. He liked to lie on the floor next to my bed and would frequently leave his cow hooves there for me to step on when I was getting out of bed. Although I did not remember doing that, that was something that I could envision doing & just keep on going.

That particular ulcer took about 6 months to heal. After that, I started paying more attention to my feet and now check them every day. I have always seemed to have problems with my feet though. My podiatrist when I lived by Harrisburg used to joke that I was in there so much he was going to put a sign on one of the exam rooms “Kelly’s room.”

When the ulcer from h*ll started in March, 2005, I was checking my feet daily. I found a small crack on the heel of my foot from my skin being dry. I did what I was supposed to do and immediately called my podiatrist’s office to get an appointment. His office was always very good about getting diabetics in right away - they always asked when I called for an appointment if I was diabetic. I started treatment for the ulcer right away.

Unfortunately, the ulcer was not healed when I moved away in June. That meant finding a new doctor. The doctor I moved away from was someone I had seen forever and he was very good. I had a 3 week wait to get in with the new doctor and it did not matter to them that I had an ulcer or was diabetic. I guess that should have been my first clue!

I started having drainage from the ulcer plus was having pain in my foot. Both of those were dismissed by the new doctor. The Sunday of Labor Day weekend, I got really sick. Because I have gastroparesis and a history of stomach problems, when I was sick in the stomach, I “assumed” it was related to the gastroparesis. By Wednesday evening, I could barely get out of bed and even Ginger Ale was making me sick so it was off to the ER.

One of the things the triage nurse does when you get to the ER is check your temperature - mine was 103. I did not even realize that I had a fever. The ER doctor came in and talked to me, did some blood work & an x-ray of my stomach. He later came back in and asked besides being diabetic, what other health issues did I have going on. He said that they wanted to admit me to the hospital. After he walked out of the room, I looked down and saw the blue surgical shoe on my foot and realized that I had not mentioned the ulcer on my foot. It was also pretty obvious and he did not ask about it either.

After I got up to a room, another doctor came in to talk to me. He asked me about any open wounds and I told him about the ulcer on my foot. They were going to call a podiatrist and I gave him the name of the one that I had been seeing. Another doctor from the podiatrist’s office came in. She was the one that informed me that my SED rate was very high, which was a sign of an infection. An infectious disease doctor also came in. He ordered a culture of my foot. A couple days after being admitted, I had a big purple bubble on the bottom of my foot. The infectious disease doctor was surprised that when they did the culture, they did not break that. When the culture came back, I was told that I had a little bit of everything growing in there – Streptococcus agalactiae, Staphylococcus aureus, candida species and Enterococcus avium.

The podiatrist ordered an MRI. I went for my MRI Friday evening. Saturday morning, the podiatrist came in and she said that the MRI was not in my chart yet. She was going down to radiology to look at it. She said that if there was a problem, she would come back & talk to me. She would not come back unless there was a problem. She did not come back so I “assumed” there was not a problem. Later, the infectious disease doctor came in and said that I had osteomyelitis - an infection that set into the bone. I later found out from the podiatrist’s partner that she disagreed with the radiologist about the osteomyelitis and she did not think that I had it. Needless to say, the radiologist was right!

I had a PICC line put in so that I would be able to have IV antibiotics after being released from the hospital. I was released from the hospital on Wednesday, one week to the day after being admitted. The hospital made arrangements for home nurses to come in and the antibiotics to be delivered.

After I was home, my foot kept looking worse. I made an unplanned trip to the doctors on the advice of the home nurse. That was a wasted trip. On the encouragement of my sister (a nurse) and the home nurse, I made an appointment with a local wound center that was connected with the hospital that I had been in.

My sister took me to the first visit and was in the room when everything was being discussed. The doctor decided to continue with the antibiotics and hold off on any surgery. He did another culture.

My sister took me to the first visit and was in the room when everything was being discussed. The doctor discussed possible surgery, putting antibiotic beads in my foot or just trying antibiotics to start with. He made the decision to try the antibiotics and hold off on any surgery. He did another culture.

A few days later after the culture came back, the doctor at the wound center called to inform me that I had MRSA. I had Staphylococcus aureus, which was showing up as MRSA, and also Pseudomonas aeryginosa infection. They would be switching the IV antibiotic that I was on to Vancomycin and also started me on oral Cipro.

To be continued …