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.