Cast Off

Last Tuesday, when they took my cast off, they discovered that the ulcer caused by the staph infection had healed completely. No new cast would be required.

They also discovered that the cast had been wound too tightly. The skin on my right leg was all wrinkled and bruised black from the excessive pressure.

The doctor was mad. She has been trying for years, ever since she moved to the Wound Control Center, to get people to avoid winding the cast so tightly it causes more damage than it repairs.

That was almost a week ago. The bruise has been healing. Instead of a solid black / indigo / purple color, parts of my leg have lightened up to an angry red and normal flesh color appears over about a quarter of the surface. It doesn't hurt unless I touch it -- as when I'm putting on my support stockings, a process that is sometimes painful even when I'm not sporting a giant bruise on my leg.

I have another appointment for this coming Tuesday. Tomorrow I'm going to call to cancel it. I'm confident my leg will continue to recover without any more help from the Wound Care Center.

Unless a spider bite becomes infected. I was bit / stung again, early this morning, this time on top of my left foot.

Healing Progress

I had just taken my insulin but hadn't started fixing breakfast when my cell phone rang. It was the Wound Care Center, asking me to come in ninety minutes earlier than scheduled. Impossible! It would take me half an hour to drive there and, with insulin freshly injected, I had to eat breakfast first. We compromised on me coming in an hour early, at 10:00. Delia would be unable to accompany me, having just washed her hair and having it all wet.

Last week they gave me a little plastic slipper to wear with the cast. I abandoned it as soon as I determined that my regular footwear would fit over the cast with no problem. I didn't want them to know I wasn't using the equipment they supplied, so I donned the slipper for the drive to the clinic.

I drive an old car. It has stick shift but the slipper was on the right foot, leaving a normally-shod foot for the clutch. The slipper is wide, though, and I was constantly pressing the gas pedal whenever I tried to brake. You use the brake to slow down, the accellerator to speed up. If you press both together, you get mixed results. There wasn't much traffic, but we were suffering our first rainstorm of the season and some of the drivers were skittish. I had to be exceptionally careful to arrive intact.

I arrived at the clinic at precisely the newly scheduled time. I spent most of the next hour waiting because they weren't ready for me.

Last week, the ulcer measured 42 mm. by 20 mm. This morning, it measured 7 mm. by 3 mm. They put me in a new cast anyway, wanting me to heal completely before allowing me to return to normal. The scraping they did wasn't as painful as before, either. I learned that the dark paper they placed directly over the wound was silver foil, to prevent infection, and that the gummy white paste they spread on my leg before starting to wrap is a moisture barrier.

Reyes checked where I said a spider had bit me last Thursday evening, just above the cast in back of the knee. I had been applying hydrocortosone cream since the bite and it had healed completely, leaving no evidence of the damage. We had a brief discussion of what kind of spider it might have been. I doubt it was a black widdow. We get lots of those non-web-spinning hunting spiders, and I suspect one of them got me. Reyes told me that the hydrocortosone was exactly the right treatment to use for the problem.

We went over my blood chemistry, which was nearly perfect. My blood sugars have crept up and my A1C (blood sugar average for up to the last month) was 6.5, considerably higher than the 6.1 just two weeks previously.

It had started to rain. I had to cross a large puddle to get to my car. My clean new cast got soaked on the bottom. With rain actively falling, some drivers became crazy, either slowing down too much or speeding up unsafely. The car has no heating or cooling because all of the ducting has deteriorated. I had to drive with the window down to keep the windshield from fogging up. I was even more cautious than before. I had no problems arriving safely.

I'm not suffering much pain, despite the necessary scraping of the wound. I'm not going to convey that fact to my family, though. The doctors have told me that I should always keep my leg elevated, but it's hard to do so if they don't think I'm suffering.

Leg in Cast

I'm not supposed to be sitting here at the computer. I'm supposed to keep my leg elevated at least as high as my heart.

Early Monday morning, Delia took me to the Wound Care Clinic in La Jolla. We left early in case we had any problems finding the place. I had a written set of directions given me when I called them a week before, but it was our first visit there. Delia doesn't listen to me when I tell her anything about driving, so she completely ignored me when I told her to turn into the hospital complex. There was, however, another hospital complex we got onto by turning at the next street.

I knew we were at the wrong place. I couldn't convince Delia. She stopped repeatedly to ask directions from strangers, none of whom had heard of the Wound Care Clinic (WCC). I finally got her to turn around and return to the main road, then go back to the entry I had originally told her about (and then she insisted I had said nothing as we originally passed that street, having previously ignored me). Once inside the correct complex, we found the place with no difficulty. Once there, I realized I had been there once previously, with one of the kids, probably Cathy, to visit a medical office in a nearby building.

In fairly short order, we got the volumes of paper work out of the way and Ursula, my case supervisor, took a look at my legs and feet. She measured the blood pressure in each arm and each leg, the arms running 170/60 and the legs 178/63. She used an ultrasound probe to get doppler readings of the pulse in my feet, instead of trying to listen with the usual stethescope. Measurements done, she smeared Lidocaine on the wound and we all waited for Dr. Rayan.

He never showed up, having gotten himself into an unexpectedly difficult surgery.

With a curette, Ursula scraped all of the dead material off of the wound. Despite the local anesthesia, it was painful (I metabolize local anesthesia so fast it is practically useless on me, as several dentists have learned over the years and even more refused to admit). Ursula dumped on more Lidocaine, assuring me the doctor would remove even more stuff from the wound.

Eventually a redhead who identified herself as Ray or Reyes showed up, a replacement for the missing doctor. She did indeed remove more stuff from the wound, at a considerable cost to me in pain, and told Ursula to put a soft cast on it, from my toes to my knee. The cast had five layers, the fourth of which was something like a sticky Ace Bandage, which the outer layer protected. That seemed a little much for a two inch ulcer resulting from a staph infection. Reyes prescribed Vicodin for me, to control the pain, then sent me to the laboratory for a large quantity of blood (six tubes) and some urine.

I'm not sure I like the Vicodin any more than the Tylenol-3, which contains codeine, because I still feel the pain. That is, the Tylenol part reduces the pain for a while but when the pain comes back, it no longer matters. You can feel it, just as before, but your body doesn't react to it. Even in the moderate amounts I was taking, I felt drugged and constipated and had difficulty waking up the morning after taking it. Others in my Thoracic Park group have made similar observations, so it isn't just me.

Reyes did say I could resume my walking, so long as I elevated my leg afterward. She also said I should resume taking my Actos, to control my blood sugar, which Dr. J had me stop for fear of swelling keeping the wound from healing. Having not taken the Actos for over a week, it was as harsh as ever on my intestines. I am still not comfortable after eating ... for hours and hours.

I return to the Wound Care Center next Tuesday for examination and, probably, more torture and a new cast.

Next summer, Reyes says, I am not to remove my support hose for relief from the heat.

New Leg Problems

The skin on my legs just above my feet is very delicate. I can't use tape there because it would pull the skin off, leaving a hole that would develop into a sore.

During the summer I had no protection on my legs because I wanted to keep as cool as possible in the heat. I brushed against the lids of some cardboard boxes, scraping holes in my leg. Most of them just scabbed over and started to heal. One cluster of three became infected six days ago. They doubled in size overnight and merged into one big sore the following night.

Fortunately I already had an appointment set up with Dr. G. He took my temperature (98.8), took a culture sample, prescribed an antibiotic and sent me to my dermatologist, Dr. B. When I saw Dr. B the following morning, he took another culture sample, prescribed a different antibiotic and set up an appointment for me with the Wound Care Center in La Jolla.

There are wound care centers at Grossmont (part of La Mesa, near where I live), at Mercy and in La Jolla. The one at Grossmont is understaffed and is turning patients away ... or giving appointments four months in the future, which amounts to the same thing. I know nothing about the one at Mercy. The one in La Jolla has an excellent reputation and was able to give me an appointment in just ten days from last Friday, seven days from today.

Dr. G called me on the phone yesterday (Sunday) afternoon to tell me that the preliminary results of his culture were that I have a simple staph infection. He told me to stay on the medicine Dr. B prescribed until they learned more.

Today I had an appointment with Dr. J, my diabetes specialist. Delia drove me, so I wouldn't have the strain of driving my car and so she could meet the doctor. She and Dr. J got along very well, both being interested in my welfare, but Dr. J warned Delia that nagging me about my health was her special right and Delia wasn't to nag too.

I've been ordered to give up walking with my Mall-Walking group. When the sore heals, I'm to do exercise in a swimming pool, not by walking. For the next few weeks, until the sore heals, I'm to keep off of my feet with my feet either elevated or at the same level as my heart.

Dr. J very pointedly informed me that if she has to order my foot chopped off, I'll be in a wheelchair for eight months before they can even consider getting me a prosthesis, which we are unlikely to find. I weigh too much for an artificial leg to be very workable.

Delia lapped it up as if the thought of me being stuck in a wheelchair was sweet. On the way home she outlined ways she was going to control my diet (by doing all the grocery shopping and throwing out my "junk" foods).

I suppose I'm not supposed to be sitting here at my computer, either.