HARD WATER...Becoming...
4-03-03
Sometimes it
seems you can’t win for losing. Once
again, on the threshold of surgery to get my left hip replaced, the operation
has been postponed. This time it was not
my doing, though. We got a call from the
office of the hip surgeon, Dr. Dayan, Wednesday morning, saying that due to a
family emergency, all surgery had been cancelled. I hope the ‘emergency’ is the birth of Dr.
Dayan’s fourth child. He warned us that
it would be taking place “sometime in April”.
*sigh* I’m happy for him, of course, but I suspect
it will be another three weeks before I can get an OR (operating room) date.
The first
delay, while not exactly my doing, had to do with me. After the surgery to replace my right
shoulder, I found myself not exactly bouncing back. I had more pain to begin with, though Dr.
Struhl thought the problem was due to the type of anesthesia that I had had this
time. The first shoulder had been
replaced under a nerve block, and that could not be done for the second
shoulder because my blood work had not returned to normal following the right
hip replacement. (Apparently it takes my
body longer than normal to remove blood thinners which are required to prevent
blood clots after hip surgery.) Hospital
policy required that any surgery be done under general anesthesia when there
are abnormal blood tests which don’t preclude the surgery completely. Since surgery done under nerve block
typically has less pain post-operatively, that was the first assessment.
You may recall
that subsequently, in BWA, May 2002, I reported: “I was recovering nicely from
the surgery until two weeks ago when I started walking with crutches
again. It seems to have put excessive
strain on my arms, because, since then, there has been a marked increase in
pain, making prolonged interaction with a keyboard unpleasant. The physical therapists agree, and have
suggested that I go back to using a walker.
Meantime, Gary is typing this for me to e-mail to Lucy.” These were doomed to become famous last
words. The pain continued to be a
problem. Additionally, I continued to
not feel good. I generally had no
energy, I was depressed, I had low-grade fevers and chills (never high enough
to be really alarming or long enough to indicate a specific problem.) I kept going to the medical doctor, Dr.
Hegazi, to treat things that seemed to be coming up...sinus infection, bladder
infection, pneumonia. Meanwhile I kept
worrying about going into septic shock from some low-grade infection like
those. I began to think maybe I was
scheduling these surgeries too close together to give myself time to really
recover. I wondered if I was having a
delayed emotional reaction to the episode of delirium after the first hip
surgery (in reaction to the antibiotic then had given me). I just didn’t feel good. Nevertheless, we scheduled the left hip
replacement surgery for September 10, 2002.
A couple-three
weeks before then I had begun wearing a bra again since it seemed like the
shoulder scar had healed completely.
Within a few days I got an area of redness in the scar. I showed it to my physical therapist who
suggested it was irritation from the bra strap, so I stopped wearing a bra
again. However it didn’t go away; in
fact it seemed to get larger. So I
showed it to Dr. Hegazi when I was getting my clearance for the hip
surgery. He diagnosed cellulitis and put
me on an antibiotic. He also told me to
go back to Dr. Struhl and have him look at it.
Dr. Struhl did not like the looks of it, and he and my hip surgeon, Dr.
Dayan, had a conference which resulted in putting the hip surgery on hold until
it was clear what was going on. About a
week later the area was still there and getting no smaller, so Dr. Struhl tried
to get a culture from it. It didn’t
exactly look like an infection, and my blood work also did not exactly look
like I had an infection, but there was one test that had come out excessively
high. (All the others were within normal
limits.) Still, something wasn’t looking
right, so he started doing a work-up for infection in the shoulder. This process, however, was hampered by
the HMO’s delay required to approve all
testing. In the meantime, the reddened
area finally changed...for the worse. An
area developed which was clearly a pus pocket, and then started “pointing”
(basically coming to a head, like a pimple does, and getting ready to rupture). It was clear, then, that I had an infection
going on and the question was where...in the bone or in the tissue. Dr. Struhl took more cultures and tried to
arrange a particular kind of scan called an “indium scan” which he felt would be diagnostic. Well, it turned out that this test could not
be done by the Hospital for Joint Diseases because, apparently, they had not
paid their bill for the material necessary to do the test. So first, I went to have a special x-ray in
which the shoulder would be fluoroscoped and a contrast media[1] would be
injected to see where it went in my joint.
The media was injected into the rear of my shoulder and where it went
was directly to the pus pocket. This did
not look good, but nothing clear-cut was apparent either. So, Dr. Struhl arranged for me to go to St.
Vincent’s in order to get the indium scan, which is a two-day test. They have to inject the stuff one day and
then do the scans the next day. In the
meantime, he continued to want more blood tests because nothing was showing
anything definite. We were running
around two or three times a week going to different places to get different
tests done. (Partly this was because I
had started having palpitations and showing an enlarged heart, which had to be
cleared before any more surgery.)
Everyone in Marc’s office was becoming very familiar with my
problems; Dr. Struhl was not so
lucky. Every test turned out negative
except that first aberrant blood test.
Finally there was nothing else to do but to open the shoulder up again
and see exactly what was happening.
The exploratory
was scheduled for October 3, 2002, but the adventures were not done yet. At Dr. Struhl’s office on October 2 we found
out that my potassium was too low. This
turned out to be the cause of the palpitations but raised a new problem for
surgery. Dr. Struhl and Dr. Hegazi consulted, with the result
that I was to be admitted immediately to the hospital in order to get my
potassium levels up by the planned surgery.
Thus I had to go from Dr. Struhl’s office directly to the hospital (do
not pass Go; do not collect $200) with nothing packed or ready. Since it was past 5:00 by that time, I would
be too late for supper once I got there, so we detoured on the way to get
something to eat and then spent hours waiting in the Immediate Care office for
the paperwork to get done. Another
hurry-up-and-wait day down the tubes.
Marc had his laptop (and was writing his zine about this) and Gary had a
TV Guide to read, but I was going stir crazy.
The friend (Paul Birnbaum) we had with us to help with the
transportation had not been expecting to make a day of it, either, so he kindly
went out to a nearby bookstore to get me something to read. It was a very long,
very wide day.
Once they were
done with the admitting procedures, they finally got me up to a room and I
waited for someone to order the IV potassium I had been admitted to
receive. The order had not been given by
the time they took me to the OR the next morning and, in fact, it turned out that
in reality no-one was really very concerned about my potassium level. It was not excessively low, and the
anesthesiologist (who was the doctor in a position to cancel the surgery if he
didn’t approve of my blood work) said that in a patient like me who was on
diuretics for hypertension and fluid retention, he would rather have a
potassium level that was too low than treat it and then get a level too
high. So all the day before had not only
been hurry-up-and-wait, but hurry-up-and-wait-for-nothing. *sigh*
While Dr.
Struhl had not been sure what he would find once he opened the shoulder up, he
had warned me that if they found infection they would have to remove the
prosthesis completely. By now I was sure
that was what would happen, so I was not surprised when I woke from anesthesia
to discover that was the case. Dr.
Struhl had reported to Marc, while waiting for me to wake up, that they had
found and cleaned out a bunch of “grey slime”, removed the prosthesis, and
packed my arm with an antibiotic-containing “spacer” material which would hold
the area open.
The plan at
that point was to begin treating me with IV antibiotics until the cultures grew
out which would determine which antibiotics were specific to whichever bug I
had. Once again the best-laid plans
never quite worked out. Despite numerous
cultures taken, pre-operatively in Dr. Struhl’s office and then, during the
surgery, of the ‘grey slime’ and surrounding bone and tissues, no bacteria ever
grew out. There were innumerable
possible sources of infection because of the bladder infection, the pneumonia,
the sinus infection as well as my gums and mouth (which are in very poor
condition due to multiple root canals, post-root-canal infections, and
generally bad mouth care on my part) and both normal and abnormal bacteria from
the skin. (Poor mouth care was a
particular concern because they had told me after the last surgery that I would
need to be especially careful to brush my teeth well, since people with
multiple joint replacements were more prone to infection in the joints coming
from infection in the gums. I had
thought at the time that they had just then pointed that out because they had
gotten a good look at my teeth when they were giving me the general anesthesia
required because of the abnormal blood work.)
Since I would
be going home to an expected 4-6 week course of IV antibiotics, a permanent IV line (called a PICC line, for
“peripherally inserted central catheter”) was put in, again under fluoroscopy
in order to be sure of it’s position, the day after surgery. A home-care agency nurse would come in once a
week to change the dressing on the IV site and provide physical therapy. Finally after a week of “no growth” there was
no alternative but to send me home on the combination of various drugs they had
been giving me since the operation. Dr.
Wise, the specialist in infectious diseases who was assigned to me in the
hospital, thought it was probably a staph infection with an uncommon variety of
staph. He told me the name, but I can’t
remember it (except that it started with an ‘f’ or an ‘h’). He characterized it as “indolent” given the
very slow development of the infection to begin with and the lack of growth in
the cultures everyone had taken. (Some
types of bacteria will not grow in culture at all if, during the course of
treatment, an antibiotic had been given, and I had been on Keflex for a month
by the time of surgery. The antibiotic
does not cure the infection because the bacteria grow a protective coating
rather than succumb to the drug, and the coating then prevents any culture
growth.)
Home-care came
to the house the same day I was released from the hospital, and Gary and Marc
learned how to give the IV drugs.
Everyone involved was concerned that we all do the safest thing, so the
antibiotics ended up being 7-8 weeks.
Then we had to wait for 4-6 weeks to make sure no infection
re-occurred. They kept in the PICC
line in case there was any problem during that time. PT was almost a joke because there is very
little you can do with one bad hip and no right shoulder. The missing shoulder was the one I would
normally use to support my bad hip with a crutch. I learned to eat and do things left-handed,
and I read a lot. Oddly though, by the
time I was through with the treatment
for the infection, I had developed more range of motion with no shoulder than I
had had after the replacement was first put in.
December 27,
2002 I went back to the hospital for an uneventful replacement of the right
shoulder prosthesis, and came home after one day for the final, probably
unnecessary extra week of IV antibiotics.
The home-care nurse removed the PICC line, and Gary nearly fainted when
he learned that the catheter had gone into the vein in my upper arm, across my
chest and into to the right atrium of my heart.
(And he nearly faints again each time he learns that again.)
Lately (as I write it is 4-3-03 -- the day we had planned to
finally get my left hip replaced) I have realized that I must have been feeling
very bad for those weeks of infection because I feel so good now, and have not
felt this good for a long time. There
are times when I just can’t get over how good I feel. In retrospect, it is even possible that the
pneumonia, sinus infection and bladder infection came from my arm and not the
other way around. My first post-op
(after the removal of the prosthesis) visit to Dr. Struhl, he asked if/how I
was feeling better and I explained that I had been feeling sort of generically
ill for a long time and that feeling was gone.
PT is going very well and I have full passive range of motion and almost
full active. Dr. Dayan, when he learned
that I would not be able to have his surgery for several months, had suggested
a steroid injection in my hip to help alleviate some of the pain. I had that done a couple of months ago and it
has made a marked improvement. (It
turned out that a lot of that pain was a bursitis caused by the
arthritis.) I’m able to get around with
crutches again and to get to the computer (and my computer games), and I’m even
doing a zine again!
As I said
earlier, I expect to be able to get the hip surgery re-scheduled in the next
three weeks. It turns out that the delay
is fortuitous for me too, because once again during pre-op clearance we
discovered significant fluid retention.
While Dr. Hegazi was not going to hold my pre-op clearance for it to
resolve, he had talked to Dr. Dayan
about possibly admitting me the evening before surgery again, in order to give
me IV lasix to get rid of it. Now there
is time for the oral medications to work.
I’m wondering if it is possible to have psychogenic pre-op edema. My default position is to blame anything that
happens to me on “my head”, as in maybe it’s all in your head. Maybe if I get hit in the head with that
often enough I’ll finally begin to learn/believe maybe it’s NOT all in my head. :)
Some members of
BWA include lists of the books they have read between disties, so I thought I
would do something along those lines.
The following is the list of books I read during the 6-7 weeks of IV
antibiotics, when I couldn’t do anything but read or watch TV. Marc typed it in for me while we waited to
see if the infection would re-appear.
THE EAGLE OF THE NINTH--Rosemary Sutcliff
THE SILVER CROWN--Robert C. O'Brien
THE MONK WHO VANISHED--Peter Tremayne
FIRE AND HEMLOCK--Diana Wynne Jones
THE MAGICIANS OF CAPRONA--Diana Wynne Jones
THE TIME OF THE GHOST--Diana Wynne Jones
THE HOMEWARD BOUNDERS--Diana Wynne Jones
CAT-A-LYST--Alan Dean Foster
MID-FLINX--Alan Dean Foster
PHYLOGENESIS--Alan Dean Foster
INTERLOPERS--Alan Dean Foster
REUNION--Alan Dean Foster
THE TAR-AIYM KRANG--Alan Dean Foster
CYBER WAY--Alan Dean Foster
WELL OF DARKNESS--Margaret Weiss & Tracy Hickman
GUARDIANS OF THE LOST--Margaret Weiss & Tracy Hickman
THE OUTLAWS OF SHERWOOD--Robin McKinley
ROSE DAUGHTER--Robin McKinley
[THE CIRCLE OPENS 1] MAGIC STEPS--Tamora Pierce
[THE CIRCLE OPENS 2] STREET MAGIC--Tamora Pierce
A HIDDEN MAGIC--Vivian Vande Velde
ACORNA'S PEOPLE--Anne McCaffrey & Elizabeth Anne
Scarborough
ACORNA'S SEARCH--Anne McCaffrey & Elizabeth Anne
Scarborough
TO RIDE PEGASUS--Anne McCaffrey
PEGASUS IN FLIGHT--Anne McCaffrey
PEGASUS IN SPACE--Anne McCaffrey
THE QUEEN OF ATTOILA--Megan Whalen Turner
THE THIEF--Megan Whalen Turner
GRAVITY DREAMS--L.E. Modesitt, Jr.
THE PARAFAITH WAR--L.E. Modesitt, Jr.
STAR OF GYPSIES--Robert Silverberg
HOT SKY AT MIDNIGHT--Robert Silverberg
AT WINTER'S END--Robert Silverberg
AN OLD FRIEND OF THE FAMILY--Fred Saberhagen
STEALING THE ELF-KING'S ROSES--Diane Duane
BRIGHTNESS FALLS FROM THE AIR--James Tiptree Jr.
GIDEON'S TRUMPET--Anthony Lewis
LIFE AMONG THE ASTEROIDS--Jerry Pournelle & John F. Carr,
eds.
MAIRELON THE MAGICIAN--Patricia C. Wrede
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A note on
the title: As before, the concurrence of
the APA NYU annish collation and the next BWA collation, as well as the
(hopefully) interest from people in both apas seemed too good to pass up. Therefore I have combined the titles for the
occasion. Mailing comments will not be included
in the APA NYU zine.
This has
been Hard Water... Becoming...
for BWA, APA
NYU and Friends
from Donna
Camp
1088 East
40th St.
Brooklyn NY,
11210
phone:
(718)692-2373
e-mail:
campground@acedsl.com
home page:
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