The Wound VAC

It's bizarre to me to think that 17 days have passed since I last blogged, 18 days since I had the necrotic flesh removed, 34 days since the mauling. At times it seems like the time has flown. At other times, I feel like I'm stuck in the Doldrums. The healing process has taken a lot out of me. My mood swings from tearful and sad to angry and frustrated to listless and apathetic. I'm tired all the time, and doing the littlest things wipes me out. I take naps and wake up feeling exhausted. I was told to eat a lot of protein, so I've been loading up on proteins, taking vitamins, and trying to eat lots of fresh, healthy food. Still, despite all the eating and being mostly sedentary, I've lost 4 pounds. I'm drinking a lot of water, but I still feel thirsty.

Up until this past Wednesday, the visiting nurses were coming in every day to check on me, check my vitals, and to irrigate and re-pack the wound. I had follow-up appointments with my surgeon July 1 and July 6 with additional debridements. Instead of three holes and a Swiss Cheese leg, I ended up with just one big mother-f*cking hole. As of July 7th, it was 7.7 cm long (3.03"), 3.4 cm wide (1.34") and 2.2 cm deep (0.87"). I developed a bacterial infection, which a culture swab showed to be three different types of bacteria -- Pseudomonas, Proteus mirabilis and something else from the Enterobacteriaceae family the nurse couldn't even pronounce. They started me on a 14-day course of 750 mg of Ciprofloxacin 2x/day last Friday morning (July 10), so I still have 6 more days to go with that. The Cipro gives me TERRIBLE heartburn and acid reflux and also makes me feel dizzy. At least the acid response I can control with Pepcid AC. I found as long as I take the Pepcid at least 15 minutes before the Cipro, I can stomach it.

Up until the past week, I was continuing to experience a lot of swelling and a lot of acute pain, and I still needed the Percocet to manage it. I don't know if it was the Cipro knocking out the infection or just the passage of time, but at least for the past 5 days, the pain has settled down to a dull roar, and I've been able to manage it without any Percocet, which is a good thing. I still get some occasional burning and stinging, but mostly now I'm getting a lot of itching and general tenderness in the area.

Anyways, on my last surgeon appointment July 13th, my doctor said I was finally ready for a wound VAC, which is another good thing. She'd told me all along the wound need to be "clean" before a VAC could be used, and the wound was finally clean. The rental VAC unit arrived via UPS Tuesday, and the visiting nurse installed it on Wednesday morning. VAC stands for Vacuum Assisted Closure. It's a medical device that provides controlled negative pressure to draw out fluids and to promote wound closing. It stays on 24 hours a day, 7 days a week. The pressure setting for my wound is 125 mm Hg (millimeters of Mercury), so it's not a whole lot of pressure when you think about it. A GranuFoam dressing (like a black sponge) gets stuffed into the wound hole, covered with a clear adhesive drape (like Saran wrap), and then sterile plastic tubing gets attached and connected to the VAC device and drainage canister. The GranuFoam is supposed to assist in the formation of new granulation tissue inside the wound.

I've heard from multiple people that I'll be amazed at how quickly my wound heals with the VAC, so I'm anxiously awaiting the miraculous results. The VAC is not painful, but I do feel the constant suction pressure. There's a presence on my leg I can't ignore. Carrying around the 3 pound VAC device with the drainage tube hanging all over the place is kind of hard to ignore as well. Then there's the occasional slurping sound it makes as it draws the drainage through the tube, like when you suck on a straw in a drink that's mostly empty (gross, I know).

The visiting nurse now comes only Monday, Wednesday and Friday to change the VAC dressing. The other days are just resting and recovering. I see my surgeon again this coming Monday, July 20, and I can't wait to hear what she says about the progress. All I care about right now is getting the hole in my leg closed so that I can go back to work and try to resume a normal life. I'll worry about the horrific scar I'm going to have later on.

My friends have been absolutely AMAZING, helping me out with rides, company, food, etc., and out-of-state family and friends have cheered me up with phone calls, get-well cards and care packages. :-)

On the legal front, at least my complaint against the dog owner finally got filed on July 14. It took a month. She has been charged under 3 P.S. § 459-502-A with the summary offense of harboring a dangerous dog. I got the notice of trial in the mail yesterday, and the dog owner's trial is set for August 26, another six weeks away. It's frustrating to me how long the process has taken.

Necrosis

Don't worry - I am NOT going to post pictures to this one! I have pictures for anyone who wants me to email them, but I don't want to be responsible for anyone passing out in their chair after being subjected to the photos without warning. Still, this post is not for anyone with a weak stomach.

I had (what felt like to me) a major set-back this Monday morning. On June 23rd, I'd had 5 of my 11 stitches taken out, and I'd finished up the 10-day course of Augmentin on June 24th. Things seemed to be going well, and the leg seemed to be healing. I returned to work, and I tried to return my life to normal, albeit with a limp. Over the course of the weekend, though, the lacerations on the top of my leg started to look worse and worse. There were still no signs of infection, but the skin around the edges started to look kind of a yellowish white and beyond that, the edges were bright pink and seemed inflamed. By the time I washed my leg on Sunday afternoon, I was really concerned. The yellowish white area seemed to have spread, some of the skin looked brown, and parts that once had seemed to be healing looked sunken and sickly. When my Doctor neighbor stopped by to check in on me Sunday night, she told me I needed to pull up my follow-up appointment and get in to see the surgeon right away on Monday. I'm glad I did.

The plastic surgeon squeezed me in Monday morning, and I learned that the whole area around the lacerations had become necrotic. Apparently, this is a fairly normal type of complication that can occur when there is so much underlying deep tissue trauma. Wounds heal from the inside out, and there was so much healing going on in the inside that the outer layer got starved of oxygen and just died. My doctor immediately began to open up the wounds and to cut away the necrotic tissue. After I saw the first piece of flesh get removed, I closed my eyes and tried to pretend I wasn't there. There was no local anesthetic needed: I couldn't feel a thing, since it was all dead. At some point, she did start to get down to living tissue, because I started to feel stinging and burning. She packed the wounds and told me I would need a Visiting Nurse to come each day to re-pack the wounds for me and to check progress. She said it would be at least 2 weeks before I'd begin to heal, possibly longer. I wouldn't look at my leg until they had everything packed and covered in a bandage. I was starting to lose it.

The nurse got me a tissue and let me sob for a bit, and then she told me what my leg looked like. She said I was going to have to see it Tuesday anyways, so the mental image gave me a chance to try to get my head around it. She said it looked like Swiss Cheese.

I made a follow-up appointment for Wednesday, and then headed back into town. I'm pretty sure I shouldn't have been driving, as I was an emotional wreck and my leg now felt like it was on fire. I went in to the office to hand in paperwork to the Medical Department and to get some things. My boss's boss ran into me and was very sympathetic, which just set me off crying again. Nothing more mortifying than crying like a baby in front of your department's Director at the office. I was able to catch the bus home, and then I just had a complete and total melt-down.

Immediately after the mauling and in the subsequent 15 days, I never once cried or lost it. I missed the Detroit Tigers vs. Pirates baseball game I was supposed to go to, had to give up my Craft Beer School ticket, and had to give up my place whitewater rafting on a trip I'd been organizing since October 2008, but I never once felt sorry for myself. I tolerated acute physical pain, but I didn't cry. My leg looked like Hell, but I just called it the Frankenleg and figured it would heal. Monday morning was like a nasty kick in the gut, and all day Monday and even today, I've just felt overwhelmed, upset and tearful. Life likes to throw curve balls. This one was a Duesy. (how's that for a mixed metaphor?)

I'm on doctor's orders to stay at home until further notice, so I'm off work as of Monday and have initiated a short-term disability claim. I might be able to return to work before the STD kicks in, but the claim process takes time, so I figured I was better off getting it started now, and I can always cancel it later on if the healing happens faster than expected. Right now, I'm feeling down and pessimistic, and I just want to focus on healing, taking care of the Swiss Cheese Leg and avoiding any further complications. I have three holes in my leg with exposed flesh up to an inch deep, and I can't stop thinking about the possibility of a Staph infection. I suppose in that respect, it's a good thing I didn't need to be hospitalized.

I took a shower today, and following the doctor's instructions, I pulled yesterday's gauze out of the wounds and gave them a good washing with warm water and antibacterial soap. It was my first look at them. They're pretty damn gross. Basically, where there used to be two 2" long lacerations with 4 stitches each, there are now holes. Where there used to be a 1" long laceration with 1 stitch, there is now a hole. The holes are quite deep. It's amazing to me how deep human tissue goes. I always thought my Quads were in relatively decent shape, but there's a lot of skin and adipose tissue layered on top. That's a good thing, because if the dog had been able to tear into my muscle or bone instead, I would have been REALLY messed up.

The visiting nurse came right as I was getting out of the shower (perfect timing!), and my Doctor neighbor came over, too. My neighbor helped me take some new pictures of the wounds. The nurse checked my vitals and did a fresh packing. I thought maybe there would be something really complicated to it, but it's just saline and gauze. It's like Civil War wound technology, only cleaner. The nurse soaked the 2" gauze with saline, pulled it apart to its thinnest layer, and gently stuffed and tucked it into all the crevices of the wounds. She then put dry gauze on top and a large bandage on top of that. Again I felt the burning and stinging (I teased the nurse, "Are you sure that's saline and not lemon juice?"), but it subsided after about 15 minutes. I guess the wet pack keeps the wound moist and also draws the draining fluid out towards the dry gauze. Pulling out the used gauze each day helps to pull out dead tissue and to promote healing.

I've been told wounds heal from the inside out. The human body is truly a miracle. How do my individual cells know to queue up for filling in the wound? Somehow, they do. Over the next few weeks, new tissue will start to grow, and the holes will start to fill in. I'm just keeping my fingers crossed that there aren't any further complications.

Munchie, the Hell-hound

Saturday, June 13, I got mauled by a dog. In 37 1/2 years of life, I've never had a serious injury (just some sprains, bumps, etc.), so this was pretty major for me. I'd gone over to my friend Nancy's house to help her with yard work. We were planning a big picnic party for June 27th, so this was to get the yard ready for the party. I'd dressed in jeans and a T-shirt I didn't care about, had my mug of hot coffee, and was ready to get dirty.

I arrived around 11:40 AM or so. There was a sign on the front door to come around back. I walked around to their backyard fence, and looked for Nancy. Two dogs were running around their large, fenced-in yard. Nancy had written on the sign that the dogs were friendly, but they didn't know me, so I waited outside the gate until Nancy came back outside to let me in. Nancy's dog, Seamus, who looked like a Setter mix, was a love; the kind of dog that thinks every new person is his new friend. I let him sniff me and lick me and check me out. Nancy explained that the second dog (I don't remember his name) belonged to her younger sister, Amy. Amy had recently moved back into the family home (apparently) due to personal and financial issues, and she had brought her two dogs with her. The second dog was definitely more excitable, and he was barking, but he seemed okay with me. The gate was loose, and though I thought I'd closed it properly, one of the dogs pushed it open, and both dogs went running out into the front yard. Nancy took off after them to retrieve them, leaving me in the back yard. That was when I noticed the third dog tied up next to a couple of trees. He wasn't barking at all, just standing there, watching things. He was a big dog, my guess maybe 100 to 125 lbs, and a mottled black color. Nancy finally got the two dogs back into the yard, closed the gate properly, and I asked her about the third dog. That was her sister's other dog, Munchie. I'd been in the back yard for about 15 to 20 minutes now, the other dogs were okay with me, so I asked Nancy if it'd be okay for me to go up and meet Munchie. I figured if I was going to be in the yard doing work all day, the dog should have a chance to get used to me, either that, or I needed to know to give him a wide berth. Nancy said it was okay, so we walked over slowly for me to meet the dog. He was standing, and his ears were perked forward, but his tail was wagging, and he wasn't barking, growling or snarling. There were none of the classic signs I would think of that would indicate an aggressive dog. His hackles weren't raised; he wasn't hunched back, nothing. I wasn't scared or nervous, and I talked to him as I walked up, saying something like, "Hi, Munchie!" or whatever. Nancy was right by my side. He let me approach him, and again, I saw no warning signs what-so-ever. I held out my right hand so that he could sniff it. He sniffed my hand, and then put his head down slightly, like he was sniffing my legs. There was a pause for a moment, and I swear to God, the dog was thinking about what he wanted to do.

He decided to lunge for me, biting my abdomen and fortunately getting mostly just my jeans button and zipper. It was totally without any warning and without any provocation. There was no food around. I hadn't touched the dog. Nancy was standing right by my side, and the dog had seen me interacting with the other dogs, so he knew I wasn't an intruder. There was no explanation for it. As he bit my abdomen, I registered that the dog was attacking me, and I started to pull back away as fast as I could. The dog let go of my jeans, and then he sunk his teeth into my upper left leg. I think at that point, I started to scream. He knocked me down, and fortunately, I fell backwards, away from him, and he was still tied up. He started to maul my leg, tearing and snarling. I remember I was screaming and hitting him in the head with my hands, trying to pull myself away from him. I have a couple of nicks on my right hand where I probably caught his teeth when I was hitting him. Meanwhile, Nancy was desperately trying to pull him off me, yelling at him and pulling on his collar. He let go for a second, and Nancy was able to pull him away as I rolled on the ground away from him. I think I took two or three rolls on the ground, then I got up and tried to hobble as far away from him as I could. I wigged out for a couple of seconds, just screaming "Oh my God! Oh my God!" at the top of my lungs, and then I started to calm down. I think that was when my brain was starting to release the Endorphins.

Nancy came running up to me in a panic and asked if I was all right, what she should do, etc. I was clutching my leg with both hands, and I pulled my right hand away from my inner thigh. My hand was covered in blood and a yellowish, oatmeal-looking substance that I realized was fat tissue torn out. It looked pretty bad, and I thought to myself, what if he hit my femoral artery?, so I asked Nancy to call 911 and to bring me a towel.

I think the most terrifying thing about that damn dog is that as soon as Nancy got him off me and I rolled away, he heeled. He didn't continue to bark or snarl. He just stood there quietly, at attention, watching me. If I had still been within his reach, I believe he would have attacked me again. This was NOT a dog-gone-wild kind of attack. He did not turn on Nancy. For the dog, it was a very controlled, deliberate attack. It was his reaction after the attack that makes me absolutely convinced that he was trained as an attack dog.

Having the dog stare at me was freaking me out, so I hobbled out to the front yard to get away from him. Once in the front yard, I asked Nancy to make sure the gate was closed, and then I laid down on my back, with the towel on top of my leg. Nancy was on the phone with 911, and we were both trying to apply pressure to my leg. By now, the Endorphins were working their magic -- my leg felt mostly numb, and I just felt very peaceful. It seemed like the paramedics arrived pretty quickly. They got my jeans cut off and assessed the wounds. I made an effort not to look, because I was feeling okay, and I didn't know how I'd react to seeing them. A police officer came, too, to take a report. The paramedics applied a temporary dressing, got me loaded up onto a stretcher, and put me in the ambulance to go to UPMC Passavant. They asked me if I had a preference on ERs, and I told them I had no idea where I was, so they should take me where ever they thought was best. My first ambulance ride! I got oxygen; they put some heart rate and BP monitors on me, and they put in an IV port. Game 7 of the Stanley Cup Finals had been the night before, so there were a lot of jokes about my being a Red Wings fan.

At the hospital, they cleaned out the wounds, trimmed away some loose flaps of skin, shot my leg full of Novocaine and gave me eleven stitches. The stitches were spaced far apart because the wounds were so deep, and they said they needed to be open in order to drain. The deep puncture wounds without tearing they left open. Once I was in the hospital, I dared a look at my leg, and I didn't pass out. It looked pretty bad, but there weren't any huge chucks of my leg missing or anything. There was a ton of paperwork to fill out, including a dog bite report they needed to do. They also gave me another tetanus/diphtheria shot, just in case. FINALLY, at the very end, they gave me a double-dose of Augmentin and a Percocet for the pain.

Nancy had called some other people who were planning to come over to help with the yard, to tell them not to come. A friend, John, lives very close to UPMC Passavant, so when he heard what had happened, he came to the hospital to be with me. Nancy was tied up with the police officer and was also an emotional wreck after what she had witnessed. John stayed with me at the hospital, drove me home, helped me get upstairs, went to the pharmacy to fill my prescriptions for the Augmentin and the Percocet, and he stayed with me all afternoon, all night and Sunday morning. He was SO awesome; he just took care of everything for me, including bringing me my pills and water when I needed them. Basically, the only thing I had to do was get up and go to the bathroom.

He also set up a website for me through Lotsa Helping Hands. I woke up, and he said, "Here, let me show you the website I set up for you." Lotsa Helping Hands is a free website that allows you to have a secure community to coordinate help efforts for any person in times of need. He'd set up an entire week of lunches, dinners, my ride to the plastic surgeon on Tuesday, and then he'd broadcast the website to all of our circle of friends to get them to sign up to help. I was also able to add my own help requests / tasks to the calendar as things came up, like a ride to another doctor's visit last Wednesday. Fifty-two of my incredibly-awesome-amazing-generous friends signed up to help, so many that I literally couldn't use all of the help that was offered. It was a huge relief to be taken care of so well after the injury, especially since I had so much trouble walking and was taking so much Percocet for the pain. Yeah, once the Endorphins and the Novocaine wore off, I was in a lot of acute pain. The best way I can think of to describe it is to imagine a 100 fire ants biting your leg.

There's more to tell, but that's probably enough for one night. Through all of this, I feel so lucky and so blessed with my friends, with my job, my very-understanding boss, my health care coverage, and with the fact that Munchie really only got my leg. The injuries could have been so much worse, especially if he'd been able to get at my face. So, in spite of everything, I have to feel grateful.

A drink I should never have again

I love margaritas, but I've been trying to watch my nutrition, and I think a margarita has to be about the worst drink in the world for you. Part of the problem is most places serve them in pint glasses, so it's a large drink. A large drink with a ton of sugar and sodium. My one margarita last night was about 750 calories and 2,000 mg of sodium. That's one entire day's need for sodium in a glass. Yuck. I wish I didn't know this. :-(

I should just stick to beer and wine.

The former Union Sewer Pipe Company

The former Union Sewer Pipe Company
Originally uploaded by sjoberg_sara

I woke up bright and early this Saturday morning to drive out past McKeesport, PA for a trail clean-up volunteer activity along the Youghiogheny River. The conservation area, Dead Man's Hollow, used to be an industrial center. When the factory closed down in the late 1920s, the land was reclaimed by Nature. It became protected in 1994, and volunteers have been trying to clean up 440 acres of former dumping grounds ever since.

We spent about 3 hours wandering the trails and picking up garage, old bottles and cans, scrap metal, etc. No one bothered with the millions of pieces of broken ceramics littered all around the area of the ruins; you could never clean it all up. It's being covered by dirt and decomposing matter and will be completely buried in a few more decades.

After the clean-up, the Lincoln Fire & Rescue department treated us to a lunch of grilled hot dogs and hamburgers at the Municipal Park ball field. Then, I drove home and crashed asleep on my couch for two hours, exhausted. What a great day!

Noshing at Cross Street Market

Saturday afternoon (April 18) I was joined by five of my fellow road-tripping Pittsburgh Meeps and Maureen R. from MiNY for lunch at Cross Street Market and wandering around the Federal Hill neighborhood. The great thing about the Cross Street Market area is that there is so much variety; there is literally something everyone can enjoy. I just wish Pittsburgh still had city markets like Philly, Cleveland and Baltimore. That is probably the only time you'll ever hear me wish to be anything at all like Cleveland.

Jenn I. (who grew up part of her childhood in Philly) quickly ventured off on her own and found a Philly Eagles bar, complete with greasy Philly food. She was in Heaven. Pete B, Ruth M, Maureen R and I started off at Ryleigh’s Oyster, where we were drawn in by the promise of $5 make-your-own Bloody Marys and $2 craft beer pints. $2 pints of craft beer??? We HAVE to go back there sometime. Pete actually stayed on at Ryleigh’s to feast on oysters. Maureen, Ruth and I wandered back into the market, along with Victoria M and Michelle S (who joined us after their morning bike ride), for different eats. We loaded up on crab soup from Nick’s, fresh limeade and pretzel dogs from The Pretzel Twist, and just about the best fish tacos I have ever had from Pop Tacos.

After noshing, we found we still had room for a few slices of damn fine pie at Dangerously Delicious Pies just around the corner.

Satiated with yummy food and drink, we walked over to Federal Hill Park, where we admired a view of Baltimore’s Inner Harbor on a gorgeous Spring day that was absolutely fantastic.

This was my first chance in five visits to Baltimore to really explore the Federal Hill neighborhood, and it was definitely worth it. There were many more places that looked interesting, so I can’t wait to get back!

Going to give this a try

Well, I've given up on my old blog service (Yahoo 360), so I'm going to give this a try. I figure since three of my friends are already using Blogger, that has to be a good recommendation, right?