Saturday, October 21, 2006

Poor Mr. Foot Gets It Again

Poor Mr. Foot.

Poor, dear Mr. Foot.

Somehow, someway, he became inspired to reprise his role of 2004, when we almost lost him for good.

This time, though - this time, it will be different. Better. Better.

The diagnosis, as of Friday afternoon, is cellulitis. Yes, that awful infection of the deeper tissues that goes with things like blood poisoning and gangrene. Maybe MRSA - well, highly likely, all things considered - but the important point is, it's cellulitis for sure.

There's no abscess. Instead, worse in some ways, my entire left leg is infected from the knee to the tips of my toes.

According to my great and treasured Infectious Disease doctor, Dr. C., we caught it in the very early stages this time. Unless things change for the worse, she'll keep me out of the Awful Place, and at home. I do not not not want to go live in the hospital again.

I do not not not want to lose my leg.

I must be vigilant, and I mean vigilant, to keep things from changing for the worse.

So far, I'm on oral Minocycline again. No IV yet, no further stuff like Rifampin. She kindly wrote me an Oxycodone rx for extra pain support on top of the morphine patches, anti-inflammatories, etc. I am humbly grateful for this. The pain isn't even approaching what it did in 2004 yet, and it's bad. Tender. Touch it and I want to jump through the ceiling.

I'd been busting my butt out in the yard, wanting to make it nice for Halloween, and for the one-year anniversary of Wilma. I don't want this to be a not-completely-repaired hurricane house any more, I'm suddenly just so tired of it I can't find the words to express it. My patience with living with the remaining hurricane mess came to a screeching halt on the day the weatherman said, One year ago today, Wilma started forming out in the eastern Atlantic...

Add on this: I love Halloween. We didn't have one last year. Wilma hit us on 10/24, and everything was destroyed, roads not cleared, no power, still no water in many places. You have no idea until you live through it, truly. Last year the cops etc. asked us not to do Halloween, it was just too dangerous with all the broken glass and huge downed trees and other debris out there and no functioning traffic lights or street lights, so please don't do Halloween, not even in the daylight, it's not safe...

My whole block seems to have the same feeling about Halloween this year. We really want it, we want to do it up right.

Between general cleanup and doing Halloween-type things, I overdid it.

I was being so good about working on alternate days: one day physical labor, next day rest and stay inside...then I blew it. I worked very, very hard 3 days in a row - most of a week, actually. I acquired a bunch of beautiful used brick from an estate down the street - stuff like that. I'm good at handling that sort of thing but hell, I'm sick. The pollen is still so fierce out there, and I was covered in little *mini-MRSA's,* the surface infections, and wearing myself out working, too. Not to mention, being on immunosuppressants for so long, then recently quitting daily Minocycline antibiotics after 8 months...

aw hell. Shit happens. I need to stop blaming myself and doing the woulda shoulda coulda's here. What matters is what happens from here on out.

I felt something wrong on Thursday. I was stiff everywhere all day, and everything chronic on me was firing up. Itching everywhere, scratching my skin off, coughing and wheezing, all allergic and asthmatic.

I was finishing oral antifungals because I had thrush, a painful yeast infection in my throat. (Sounds dirty, huh?! How the heck does a person get a yeast infection in their throat?!)

The overall inflammation was ramped up - the rheumatoid arthritis condition that eats up all my connective tissues, including in my eyes and gums and ribs. It was all on fire. Then it hit a lot of new joints, too - my right hand especially.

The disseminated HSV-1 - the cold sores run amok - was making a big rash of blood blisters in my mouth and on my tongue, and the skin was coming unglued on my toes again.

I mean, everything was taking over at once. Something bad was going on.

So Thursday, I tried to make myself take it easy. And I was in enough pain, and stiff enough, that making myself STOP wasn't that hard to do. It was different than the usual RA morning stiffness - I was physically unable to close my right hand, for instance. I had to push it with my left hand and even then it wouldn't close all the way.

Thursday night, my left ankle hurt. I had one of those really bad high sprains in it in 2002. They often don't heal well; certainly mine never did, but the pain usually isn't very bad any more. On Thursday night, it hurt like hell for no reason I could see. Weird. A faded memory come back to life.

Then on Friday morning I woke up around 5am. That left ankle was warm and red. Shit. Not just the ankle any more either. The foot. The leg. I looked all around, I saw it, oh, no, oh, no no no, please no. I left a message at Dr. C's at 7am and then I worked outside - gently! - the only thing I could think of to calm myself down as I waited for a return phone call.

Finally, around lunchtime, I scrubbed and went in to the doc's. By then, the redness had crawled up my leg almost to the knee. A few hours later, it was above the knee. But by then I was finished with a doppler venous ultrasound to make sure neither leg had blood clots, and on my way to Sam's to pick up my antibiotics and a mess of other meds too. I stopped by Penn Dutch for fresh produce, and Walgreen's for the pain pills, and hit Lotus Chinese Kitchen so I wouldn't try to stand up and cook; and then I was ready, I got inside and battened down the hatch.

Here are Dr. C's instructions:

Keep it elevated, all the time for at least the weekend, most of the time after that. If anything, anything, changes, call the service and have them page me right away. Immediately. If you ever spike a fever, for example. If the redness flashes up your leg, if it gets very hot. If you feel very sick.

Yeah. I know the drill.

Mr. Foot is almost always elevated anyway. I sleep with 5-6 pillows under my feet. In front of my computer is a high stool with 2 pillows on it. In my car is a foot pillow for the dashboard. When I scooter around in stores, he's propped up on my purse in the scooter baskets.

At first glance, he looks fine. Well, usually. Relatively. But you see, he's all scarred inside from the terrible MRSA infection in 2004. Not just skin and muscle, but the tendons, nerves, bone, everything is full of inelastic scar tissue. The blood vessels and lymph vessels don't have the elasticity to pump blood and lymph back up. When the foot's elevated higher than my heart, gravity cleans out the fluids that build up when he's on the ground. I use gravity to do the job he can't do for himself any more.

It's a simple equation: The more I keep him elevated, the longer he'll stay alive. The goal is for *k* to die before the foot dies.

So the elevation thing, I got that down.

I never get fevers even when I should: the Prednisone and anti-inflammatories, and maybe also the HSV, keep my body temp around 96-97 degrees. If I ever make a fever - even if I just hit *normal* and go up to 98.6 - it's really serious. I was at 97.8 at the doc's. She noticed that. It may be my record high body temp at her office.

I'm looking at these photos from yesterday, taken while waitng for my ultrasound. The pictures are simultaneously gross, yet don't look like much is happening.

I'm showing these pix partly because what's happening to me is getting more and more common. And these infections DON'T look like we may think they should: they often are NOT all streaked and black or green or full of obvious pus. In fact, I'm beginning to think they usually don't look like much of anything at all.

If you have a tender warm reddish place on your body, SEE A DOCTOR. Don't let anyone tell you it's *nothing.* Maybe not even a doctor, okay? - if you think it's something bad and they're doing the old *it's just anxiety, here's a pat on the head and a Xanax* bullshit, SEE ANOTHER DOCTOR.

Because once it starts, you may not have much time. Don't lose body parts over stiff-upper-lip pride, or shyness, or embarrassment. It's so not worth it.


Heather said...

Chronic Lateral ankle pain is actually a type of ankle pain that develops after an injury like a sprained ankle. There are, however, other ways such pain can develop. Signs of Chronic Lateral ankle pain are as follows: First of all, the pain itself is usually on the otter part of the ankle and because of its intensity one will have trouble walking or exerting large amounts of pressure. Uneven ground or wearing high heels makes it particularly difficult to walk. There will also be swelling, stiffness, tenderness and or repeated sprains.
The most common way of developing chronic lateral ankle pain is getting a sprain and then having the area not heal completely. The connecting tissue called ligaments stretches and tears during a sprain and without careful and complete rehabilitation the ankle is at risk of additional injuries. Also, if during an ankle injury, a nerve that passes through the ankle gets injured or pinched it will cause pain. A torn or inflamed tendon, arthritis or even a fracture in the bone can also cause chronic pain.
Treatments for such ankle pain included receiving anti-inflammatory medications such as aspirin or ibuprofen to reduce the swelling. Physically therapy with tilt-board exercises which are directed at strengthening the muscles. An orthotist may recommend an ankle brace or other type of support. Your doctor may suggest an injection or a steroid medication. Future sprains and fractures should be handled with care – immobilization to allow the bone to heal is key.

Jean said...

Oh, dear k... this all sounds so miserable for you!... and scary.
Do what you have to do. Take care of yourself completely!
I will be thinking about you and will check back frequently.

Livey said...

My prayers are with ya honey, anything I can do?

k said...

Thank you all. There's nothing to do right now but sit it out till Sunday morning. Then I'll get in touch with the ID doc, and we'll go from there.

It did get worse today, not hugely, but worse enough. So probably those toxic IV antibiotics are in order. She may admit me, I don't know. Whatever comes, I'm ready for it. If it means the hospital, so be it. Usually it's at least a 5-day stay for this sort of thing. I'll get a lot of paperwork done there.

And to get me through the night, those oral antibiotics will hold me.

Updates tomorrow. For now, it's bedtime.