Saga of the Foot - Part 3

I'm going to start this post with a WARNING! The image of my wound that I'm going to include in this post will be very disturbing and downright grotesque. You'll see the aforementioned swelling, macerated skin, and quite a bit of epithelial tissue. (Epithelial tissue forms the covering of all internal and external surfaces of your body, lines body cavities, and is the major tissue in glands. (Thank you, Google.)) 

Also, I've taken a half-dose of my antianxiety meds before I started writing this. I'll try to keep my rage from bubbling to the surface, but I won't promise it. Note: I only make promises I know I can keep, so when I say I'll try, that's the best I can do.

Picking up the story where we left off, the foot and ankle specialist scheduled me for emergency surgery two days after his last examination. To commemorate this event, our planetary system orchestrated a full solar eclipse. But I firmly believe it was arranged for the general populace, not just me.

This doctor, whom I refuse to name due to the possible perception of libel, even if what I say is 100% true, was no mere orthopedic surgeon. I refer to him as a foot and ankle specialist because that was all he worked on. He was what you might call a "special specialist." Knowing this, would you like to know what he found during the emergency exploratory surgery? Nothing. He couldn't figure it out. He GUESSED that the lubricant my body was supposed to use between the joints so they moved smoothly was being produced in excess because my body couldn't comprehend that many of the bones in my foot had been surgically fused together. Thus, he stitched me up and scheduled a follow-up visit at his office during the next work week.

On that next visit, which was a Tuesday, he noted three things.

1. I was healing.
2. I was still leaking the mystery fluid.
3. The surgical site was very swollen.

To address the swelling, he had his assistant put me in a full-contact cast. I don't know why this was done. I don't understand it as a treatment. When I explain to other doctors what was done, they stare at me in horrified disbelief and ask, "HE DID WHAT?!?" All I can do is shrug. There's the suggestion on various websites that using a cast can control swelling, but what shocks the other doctors is the fact that I was still ACTIVELY LEAKING FLUID OF AN UNKNOWN ORIGIN! 

The doctor saw me two days later, Thursday, to assess if the cast was controlling the swelling. He liked what he saw, so I was put into another cast and scheduled to return a full week later.

Up next...? Labor Day weekend of 2017! Yes, falling between those two fateful visits was a federal holiday. A weekend that was supposed to be filled with friends, family, barbeques, and the remembrance of those who literally gave their lives so people could work without an ongoing fear of death on the job. But mostly it's usually filled with people thinking, No work for three days! 

And I just had to ruin it. You see, the fiberglass cast I was put into was black in color. (It was the only color the office had.) That Sunday, not only could I feel the cast soften, but I was leaving black spots wherever my foot made contact with the floor. So I did as instructed: I called my doctor's office because something was wrong. I left a message with the on-call answering service that my cast had softened from the inside, and asked if I should go to the emergency room to have it assessed. One of my doctor's partners was on call that weekend, not my actual doctor, and she said that so long as there was no foul odor and I wasn't running a fever that I could wait until my follow-up visit on the upcoming Thursday.

Dear reader, I'm not a normal patient in many regards. Thanks to diabetic neuropathy, I have no surface sensation from my knees to my toes, which is what's expected with neuropathy. That said, I can STILL feel the soles of my feet. Well, I could. That's slowly vanishing, too. But at the time this story takes place, I felt plenty, and it was... gross. Seriously, it felt like I was walking around with my own personal swamp locked inside that cast.

When everyone returned to work on Tuesday morning, I called my doctor's office with a request. Could I come in an hour early and have the cast removed so I could then allow my foot to dry off? It was a surgical site, so I didn't think it could be washed and toweled dry. I just wanted it to air-dry. The answer, which I received the following day, was a "no." They were too busy, so there wouldn't be any open exam rooms for me to occupy for an hour.

So I waited for my Thursday appointment.

Until that appointment, this specialist would call me "The Poster Boy for Compliance." I followed doctor's orders to a T. I was told not to go to the ER on Sunday, so I didn't. I was told not to show up early for my doctor's appointment, so I didn't. And for my strict compliance, I wound up with...

Brace yourselves. This is where it gets ugly.

For my strict compliance, I wound up with this:

This is the wound exactly as it appeared on

the day the cast was removed.

Seeing is bad enough, but let me explain exactly what you're seeing. The "red meat" inside the open wound is the epithelial tissue I mentioned at the start of this post. The white, seemingly dead flesh around the edges is macerated skin. The skin further away from the wound is dry from the padding inside the cast, so the pinker skin closer to the hole is wet from the mystery fluid I was still leaking. This particular angle isn't that great, but there's also massive swelling all around the wound. (Don't worry. I'll have improved angles in a later post.)

I... was... PISSED!!! I strongly suspected that my doctor's partner was too busy enjoying the holiday weekend to really take into account my complaint about the cast softening from the inside out. I don't know who was involved in the discussion about me wanting time to air out my foot an hour before my scheduled appointment - a call that I made Tuesday and wasn't answered until Wednesday! - but obviously they didn't realize the severity of what I said. 

And now... Now the specialist went from treating me like one of his favorite patients to pariah. (For those that don't know that word. It means someone who is despised or rejected.) He was quick to refer me to a wound care specialist, and then did his best to wash his hands of me. 

Because I saw this wound care doctor at a different location, I was unaware that he was actually the third doctor of my surgeon's practice. And this guy was a real treat. I've offered to discuss the subject of good and bad doctors. This guy was a BAD doctor. 

Believe it or not, it's actually unusual for a wound like what I had to hurt, but it did. Something was very, very wrong. But when I asked him to do something about my pain, he refused. Utterly, completely, 100% refused. He said I should talk to my primary care physician. I argued that my primary wasn't treating the wound, and so wasn't responsible to treat the pain it was causing. And his response to my perfectly logical argument? "Well, I'm not prescribing anything, so your primary is your only other option." 

Let's set aside that aspect and get to the horror of the wound. It measure 3.5 cm (1.37 inches) long, 1.5 cm (0.59 inches) wide, and 4.0 cm (1.57 inches) deep. He cleaned up the wound as best he could, arranged for home care nurses to visit to change the dressing and to continuously assess the wound. And that was it.

Two days later, I had my first visit with the home nurse. The dressing applied at the wound clinic had already soaked through. Not blood. There was rarely any blood at all. It was always that mystery fluid. Due to the saturation of my bandages, the nurse visits quickly went from three times a week to daily, including weekends.

To clarify how much drainage was coming from my foot, the nurses started using something called OptiLock. This sterile dressing functioned like a diaper, absorbing fluid and turning it into a gel within its layers to lock it away. On most days, the OptiLock literally filled to bursting! This was during the daily dressing changes!

During my second visit with the wound doctor, the nurse removed something that was apparently sticking to the wound and I almost jumped through the ceiling. That brilliant specimen then asked, "That hurts?" I remained silent, but looked at him with an expression that said, "No, I yelp and flinch when something feels good." And the doctor still refused to address my pain.

My third visit to this jerk... This is where I finally lost my temper. I complained about the pain again and he refused to do anything about it again. But this time he countered with, "But we ARE treating the wound."

That's when I snapped. "CONGRATULATIONS. YOU'RE OFFICIALLY NO BETTER THAN A SCHOOL NURSE TREATING A BOO-BOO!" He actually had to leave the room and take a few deep breaths before returning to finish treating the wound. 

Things became so bad with this doctor that I started to dread my visits to his office. No joke, I had literal nightmares about having to see him. Making it worse was that he was the only wound care specialist in the area. The next nearest specialist was a 45-minute drive away.

What finally tipped me over the edge was something one of the home care nurses told me. My wound was being packed regularly with something called Dakin's solution. (Basically, it's bleach water. Buying this solution premixed is costly - about $17 minimum. Learning the exact ratios and mixing the distilled water and bleach yourself is much cheaper! Around $1.29 for the distilled water, about $1.79 for generic bleach. And since insurance wouldn't cover the Dakin's, guess what we did.) The nurse told me that the solution was great for fighting bacteria, but not so great for promoting fast healing. To quote her, "Our job is to show progress in your wound care. But that's not the case with the wound care center. The longer you have the wound, the more you have to see them, the more money they make."

Thus, on 27 October 2017, I traveled the 45 minutes to see a different wound care specialist.

That adventure, however, will have to wait until next post. For now, to make up for the gross foot pic, here's a kitty performing kata.

Master Kitty says, "Flow like water."