Shellshocked

PICC

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I don’t know what else to call it. Stunned? Staggered? Shellshocked. Set back, at least psychologically, in a big way.

Donna left for her five-day sewing expo in Puyallup, Washington on Wednesday afternoon. Two hours after she left I got a call from a doctor at Tucson Medical Center, where I had knee replacement surgery on Feburary 6th. He said blood cultures taken during my three-day stay at TMC showed some evidence of a bacterial infection, and he wanted me to have new blood cultures done. These couldn’t be done at my primary physician’s lab, so I had to go by TMC the next day to pick up a lab slip, then drive to a nearby specialty lab to have my blood drawn and analyzed.

The next morning, just before I headed out to get the lab slip and have blood drawn, the TMC doc called again, seemingly upset, to tell me that in addition to the blood cultures, I needed to see an infectious diseases doc right away. He had it all set up, and gave me a number to call. I called and got an appointment first thing Friday morning.

In the meantime, of course, I called Donna, my nurse friend Mary Anne, and the surgeon who’d done my knee replacement, to let them know what was going on. I got my lab work done Thursday after my twice-weekly PT appointment (where I was able, for the first time, to do forward 360-degree rotations on the stationary bicycle). Friday morning, just before my appointment with the infectious diseases doc, my knee surgeon called back to tell me what was really going on: they’d done four blood cultures while I was in recovery after knee surgery. Of the four, one showed evidence of a bacterial infection … the other three were clean. He said they were just being cautious, and that if the infectious diseases doc wanted to give me an antibiotic treatment I should do it, just in case.

So, yesterday morning, I went to see the infectious diseases doc. She confirmed what my knee surgeon had told me. Because I ran a slight fever (100-101°) during the first two days after surgery, she felt it was best to go ahead with the antibiotics, just in case, even though I was showing no signs of infection now. She explained that there were two ways to administer the antibiotics, which were to be taken over a two-week (!) period: orally or by infusion. Medicare wouldn’t cover oral but would cover infusion, so that narrowed the options down. I’m sitting there picturing an IV, similar to the anesthetic IV they hooked me up to before and after surgery. Then she says, right, now you go to this radiology place two miles away and they’ll set you up with a PICC line, and then you come back here and we’ll get started.

PICC line? WTF? Turns out it’s a peripherally inserted central catheter. They numb you up, insert a wire into a vein in your upper arm, thread it up through your shoulder and then back down into a large vein near your heart. Then they slide a tube over the wire, pull out the wire, and put a sort of petcock valve on the end that sticks out of your arm. It’s almost like having surgery all over again, and it takes about an hour. I was in shock the whole time, not believing what was happening but knowing I had to do it, “just in case.”

PICC line installed, back to the infectious diseases doc’s office, and now they’re hooking me up to an intravenous antibiotics flow, but that’s only for the first time. For the rest of my two-week course of treatment, I’m to wear a bag around my neck and shoulder. It contains a bag of antibiotic fluid and a battery-powered pump that’s set to give me a 20-minute infusion three times daily, at 10 PM, 6 AM, and 2 PM. A clear rubber tube runs from the bag to the petcock on my arm. For the weekend, I get a huge (and heavy) 72-hour bag. Monday through Thursday, I have to drop in daily for 24-hour bags. Friday I get another weekend bag. Repeat the following week. Jesus H. Christ!

So here’s this goddamn bag, and a rubber tube leading from it to the petcock on my arm, and just enough slack in the line so that I can take the bag off and lay it next to me while I sleep. One of my most important home PT exercises involves looping a dog leash around my left foot and then pulling on it with both arms to get my leg bent back as far as it’ll go (currently 110°, shooting for 120°). Now I can’t use my left arm for fear of pulling out the PICC, and I haven’t figured out an alternate way of working that leg. I can do all my other exercises, fortunately. I don’t know what they’ll say when I go into outpatient PT next Tuesday.

I’ll have to wrap and tape the PICC when I take a shower, so I called Polly to come over to help me with that because I don’t think I can do it myself with just one hand. I’m rationing my showers: one today, another Monday afternoon. Donna gets home Tuesday night and can help again, thank goodness. I have to be extra careful with the bag and line, all the time … it’s frightening thinking of all the ways I might inadvertently pinch or yank on the line. I can’t let the dogs sit on me or share my bed at night, and of course they don’t understand.

And here’s the thing. Other than being in shock over this unexpected setback, I feel fine. There’s no evidence of an infection. No fever, no redness. I don’t yet know what the latest blood cultures show, but I’ll bet they’re negative. According to my friend Mary Anne, a supervisory nurse at another Tucson hospital, if I had contracted staph, or MRSA (methicillin-resistantStaphylococcus aureus) as they call it now, during my hospital stay, I’d be dead by now. But it’s possible there could be some lower-order bacterial infection, and if it settles underneath the knee implants it would be very bad indeed, so it’s nothing to monkey around with. As my surgeon said, do what they tell you to do, and that’s what I’m doing.

Another wrinkle: I mentioned that the TMC doctor who called me seemed upset. The analysis of those blood cultures they took during my hospital stay, Mary Anne says, would have available at the very latest five days after they took them. It was three weeks to the day when the doctor called. We think his primary concern is the hospital’s potential liability. My primary concern, of course, is that I don’t get an infection, and if I have one, that I kill it decisively.

I’m shellshocked. That’s the only word for what I’m feeling now. And I’m rethinking having my right knee done. If a short hospital stay is that dangerous, why risk it? My right knee may look as bad as my left knee did in X-rays, but it never hurt like the left one did. I could hash with it, hike with it, bike with it, and ride cross-country on my motorcycle with it. We’ll see.

Mary Anne dropped by last night with pizza. We were going to go out to a restaurant, but after the events of the day I wasn’t up for it. She fed me, looked at my PICC, read all the paperwork and cautions they’d given me, and said she’d be dropping by daily until Donna gets back. Friends are so precious.

Updates to follow.

© 2013 – 2014, Paul Woodford. All rights reserved.

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4 comments to Shellshocked

  • Charlie

    Wow! First of all, I’m glad you aren’t showing any signs of infection and secondly that you are taking the necessary precautions, “just in case”. I think you’re dead on in your assessment of the TMC doc’s angst and I’m left wondering why Medicare would cover the infusion over the oral option. The infusion method sounds like it would have to be incredibly expensive. Again, wow!

  • Thanks, Charlie! Still feeling well, but hating wearing this contraption. I will have to ask the dr. what that “oral” version entails and what it costs. A hasher friend who lives overseas tells me oral antibiotics where she lives are very cheap, but I bet under our healthcare system it’s in the 10-20K range. Of course what I’m doing now has to be way more expensive. We really do have an insane healthcare system in this country, one based on enriching private insurers and the medical industry. Now I sound like a commie, but I really wish we had national healthcare!

  • Do we know the name of the antibiotic they’re infusing? Just exactly how much could some pills cost to be more expensive than a procedure (such a quaint term) requiring anesthesia of any sort at all?

    BTW, does anyone remember what the “H” stands for in “Jesus H. Christ”? God cared enough to send the very best. Only us old geezers remember that motto.

  • gopher

    Good to see there’s no infection and anything that may be in there will be gone shortly.

    As far as the other knee goes (and file this under unsolicited advice so feel free to hit the delete key) I think the risk of infection is probably no higher than the first time around and even if you have to wear a bag for 2 weeks afterward, the increased mobility for the rest of your life has to outweigh the bag thing.
    And frankly you can get an infection by busting a knuckle working on the motorcycle.

    Personally, I’d like to see you on trail and doing all those things you’ve enjoyed over the years.
    You’ve got a lot of miles left.

    Just my $0.02

    Gopher

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