Wednesday, January 14, 2009

Two Steps Forward, One Step Back

Lately, it sure seems that way.

I saw the wound guy this morning for my weekly crater check. It is actually starting to look pretty good, for an open sore. The tissue in the wound is granulated, finally, to the surface of my skin. That is a really good sign as it means that the epithelial layer can start to move across the wound to close. However, approximately two-thirds of the wound margin was covered with a callous, which would really inhibit that epithelial movement we want to see happen.

So he debrided the wound again (this is debridement number four since I've been in treatment for this). He took all of that calloused skin off, plus leveled the wound area itself so there are no "hills", as he referred to the places where the tissue inside the wound area potentially could rise higher than the skin surface. In itself, that wasn't especially uncomfortable or even painful, but there was some minor bleeding associated with this procedure. To stop it, he cauterized the tissue with Silver Nitrate (AgNO3 for you chemists out there). Once that was on the wound surface and we got it covered, it started to hurt. After approximately a half-hour, it felt like my heel got set on fire. Walking became difficult, and I imagine the rest can be imagined pretty easily....

I didn't want to do it, but I had to break down and take some Percocet for pain. I only took one instead of the usual two, mostly because I didn't want to sleep the day away, which would happen if I took a full dose. As Martha tells me, I'm a "cheap date" when it comes down to pain medication, and she's absolutely right about that. It explains why I had so much trouble in the PACU after the Achilles surgery: it was all about the medication.... So I've been down for a little over 4 hours and I'm going back after I finish this post and eat something to settle my stomach (one of the side effects of Opoids, and not a terribly pleasant one at that).

As it is, next week on Tuesday I have an appointment with a different wound specialist just outside of Boston. I want a second opinion on treatment methods, mainly because I want to make sure everything that is being done to close this up is appropriate and aggressive enough. Everyone I've talked with tells me that the process of healing a wound like this is really slow, mostly because of the location of the wound - it is just above the point of the heel, and it is approximately 3cm wide and 2cm high. This is the size it's been at since it was initially debrided in November. And, I've been evaluated for so many different things that I've talked about in previous posts, so we've at least eliminated anything that could be going wrong. With all of that said, my frustration level is still up there because of both the slow progress of closing the wound and the intermittent pain spikes that I have to deal with.

It's such a funny thing - yesterday I had a good day. I was walking around with minimal discomfort. While I was home I walked around the house in my clogs and had very little trouble. Today, on the other hand, since I've been to the weekly check I'm pretty miserable. I know that the pain and all of the associated crap that goes with it is short-term - I expect I'll be much better by this time tomorrow. But it is still pretty lousy.

Last night I taught the first of the EMS continuing education classes for Goffstown Fire. Fittingly, it was on Cold Weather/Hypothermia, other Environmental emergencies, and Trauma. Overall I thought it went rather well, considering I haven't taught a class in a little over a year. I'm already identifying little things I want to do differently when I teach the next one, and I will make adjustments accordingly. The best part was that everyone that was there paid attention, listened, and participated. The last part needs a little more work to make it flow better, but it was a good start.

I'm looking forward to teaching the next one.

But for now, I have to get back off of my leg. The dependent position of my foot is not conducive to comfort....


Pete said...

craters, debridment, callous, AgNO3 heel is on fire just reading this.

Hang in there....pretty soon it will be 3 steps forward a none back.

Elizabeth said...

Ouch !!!
I really hope that more rapid healing progress will begin soon for you. This has been a long haul for you......

Evil Transport Lady said...

Yikes! That stinks! But hopefuly everything will "come together" soon:)

I hear you about the pain meds. My family has a very hard time on any drug. We are also hard to "put to sleep" and even the smallest amount of pain meds kills our stomachs:(

Hang in there! Hugs from PA:)

Chris said...

mmm Silver Nitrate.

I did a project on this back when I was doing my A-levels. I was low on time, so didn't bother with silly little things like gloves. I ended up with a black hand/forearm for about a week where the AgNO3 had got into my skin and decomposed to place Ag (silver) deposits in my skin cells.

Lesson learnt!