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Final Stages of Antibiotic & Surgical Recovery

Hello, once again, everyone! I wanted to update you on how (what will hopefully be) my final surgery went.

How'd the surgery go?

I was given some Versed taken back to the OR around 8:35AM. Once in the OR, they aligned the gurney alongside the OR table and asked if I could transfer over/onto the table. It wasn't too much of a problem. I had to scooch up. They had me place my arms on the side rests. Fortunately, the anesthesiologist, Dr. Lloyd was excellent (more on that later) and was able/willing to use my PICC line for the procedure. He began pre-oxygenating me right away, with the anesthesia face mask, asking for me to take deep breathes in and out ("completely fill and empty your lungs... long deep breathes"). After a few minutes of this, along with the team hooking me up to the heart monitor, blood pressure cuff, pulseox, etc. (which I approximate to be 5-10 minutes tops) he told me I was doing a really great job and to keep up with it and that I would be passing out here real shortly. Typically, for 95% of all surgeries I've had, most anesthesiologists are usually against PICC lines. I asked Dr. Lloyd about it and he said that the distance of the catheter can cause a delay in receiving and alter the volume of medications (basically due to the dead space). Because of this, usually since they use a regular IV I can feel when they push the initial anesthetics because it burns my veins. Instead, I mostly just felt it kicking in with a certain headiness feeling edging on, along with the usual/classic ringing-silence (typical of dead silence, or bad tinnitus) taking over as my senses slowly began to evaporate. I always make a game out fighting the anesthesia to see if I can remember the exact moment I lost consciousness. I have been able to do that 2-3 of the past 20+ surgeries I've had in my life. For one of my previous leg surgeries, I actually recall waking up in the OR as they were extubating me. I remember thanking all of them, from the bottom of my heart, for helping me (I'm sure much of my infectious spirit was the result of waking up early, high as a kite). You might ask, what did it feel like... weren't you choking/coughing? The answer is probably. However, at that point I truly didn't feel much of it, given the close chronological proximity to being asleep (with many of the drugs not yet wearing off and/or reversal-medications only recently given).

The "good stuff" ultimately leaves you braindead

You also have to remind yourself just how powerful general anesthesia is. Basically, the job of an anesthesiologist is to put you into a medically induced coma and drug-induced (akin to overdose) state whereby you cannot respond to (even painful) stimulus, nor breathe on your own and protect your airway. If you ever wondered why I get into the nitty and gritty of it, it's because find anesthesia fascinating for how it works and moreover, given the fact to this day that akin to antidepressants, we don't actually fully understand all the pharmacokinetic mechanisms on how/why it works. I have always thought though that you don't sleep, but rather you are in a coma and pretty it's the closest thing to brain death, without the irreversible consequences of it.

The shortest surgery, involving general anesthesia and intubation.... ever!

Anyways, I digress. While I may have been under for closer to 30 minutes, the surgery itself only took 11 minutes to complete. This involved a small incision, reaching in to pull out this antibiotic coated nail, that's pretty much the size of my residual femur, along with suturing/stapling me back up. I presume, just in case there were complications is why the anesthesiologist still took the time to intubate and protect my airway. (I had a surgery or two, prior, where they basically didn't intubate... which was interesting and not sure how that worked). Anyways, once I woke up, they stuck to the plan of performing a femoral nerve block on me. However, since that took a few minutes to perform (required me to be responsive and somewhat awake) and takes 30-60 minutes to fully kick in, I was in pain coming out of surgery. It was a 6-7, but fortunately, each subsequent bolus of dilaudid lowered my number by 1 each time. Initially they were giving me fentanyl and I truly have never had luck with fentanyl. I think they were initially against giving the dilaudid to me because when I asked, they said it was "longer acting". Since the goal was for me to go home, straight out of recovery, they were hesitant. However, fortunately I had a competent anesthesiologist that really understands and has compassion and respect for me with understanding my higher tolerance is no fault of my own. Rather, it's been 19 months of this and 10 surgeries later. I mean that's basically a surgery once every 2 months.

Homeward bound... pain appears to be well-managed with the block

Anyways, it quickly became apparent to me after waiting around for an additional hour that I felt covered pain-wise with the femoral block. Historically, I have not had much success with these sorts of blocks, but this time they truly got it right. As I sit here and type this, I am still pretty numb, although things are starting to wake back up this morning. I would say my pain has been anywhere between a 4-6 on average. There was occasionally here and there where I was maybe as low as a 3. However, now that things are starting to wake up, this new residual limb pain is projecting to phantom limb sensations and now phantom pain. My foot is all twisted up and my pain is starting to trend into the bad. Hopefully things stabilize (plus I'm due for some more pain meds, as I type this).

What else have I been up to this morning

Aside from composing this status update this morning, I had to call Ameritas home-injection pharmacy. Reason being is they contacted me yesterday evening and left me a VM. I somehow missed this message and in dire need of connecting with the pharmacist to ensure I have enough supplies (dressings, dressing change kits, saline/heparin flushes, biopatches, etc etc.) to carry me through Friday (along with my antibiotics). This is conservative because based on my pain levels, my current plan is to obtain bloodwork/vanco trough levels at UCHealth Broomfield on Wed/Thurs, and then either Thurs/Fri head down to UCHealth Anschutz for an appointment at their infusion center. As I had mentioned in my prior post, I'll be receiving a dose of Dalbavancin (basically a newer/analog of vancomycin) that has a half-life of 14 days and will carry me, treatment-wise, for an additional 1-2 weeks therapeutically whilst simultaneously allowing me tog et my PICC line pulled (potentially as early as later this week - again - pain permitting). I plan on sticking around at the infusion center for a good 15-30 minutes afterwards just to ensure I don't experience an anaphylactic reaction. It will of course, be a concern if that happens - PLUS - I'll feel like I'm dying (cuz I sort of am). In a worst-case scenario if that happened: given I'm at a hospital, although the experience be unpleasant, at least there is the peace of mind I could rapidly receive the help I need, I truly don't think this will happen, but I put it out there because I have become allergic to multiple things in the past couple of years. The immune system acts in mysterious ways. The good news though is I have never felt super-sick on vancomycin. Anyways, the thought of me being done and having my PICC line removed sounds wonderful.

Charting what's next:

As far as where I'm charting next: the plan is to attend my follow-up appointments, get my staples removed. I'll be keeping a watchful eye for any residual or new emergence of infection. The plan is to get right on that by calling BOTH my orthopedic specialist and infectious disease provider. I've got to tell you, Dr. Stoneback is one of the few: most humble, kind, caring, and compassionate medical professional I have had the pleasure of working with. He took this dumpster fire of a situation and really came to my aid in a way that I could totally imagine others refusing to do. My situation was so misguided, so mis-handed and that's the reason why (at least my Mom and I presume) he was so eager to take on/take over my case was just how dangerous and forgone things had gotten, he knew, himself that he was the only one that could really right the course and help me. While this has meant amputation, he even went as far as trying to cure me of this disease while keeping my leg functionally long (and, all the while, hopefully successfully treating it). It is going to be a month or two of retrospection, appreciation, as I attempt to move forward into walking with a truly artificial limb. While my endoprosthesis was also an artificial experience, my soft-tissues and muscles surrounding the knee and the endoprosthesis essentially acting as its own form of osseous-integration (within the body), although unmistakably still foreign-feeling and a continual source of pain, Im sure it comes closer to even the micro-processor legs/ankles that through a mind of their own and adaptable AI training data independently bend, or go stiff independently (and hopefully for my sake, predictably, to make up for the fact that none of my nerves run to them and I'm still missing out on the important feedback sensation of proprioception.

One possible solution to this phantom pain involves getting me into a socket/prosthesis ASAP!

Regardless, the sooner I get in and trick my brain that a leg that I cannot feel, that is presumably mine is still attached, the sooner this phantom pain might be able to abate. Unfortunately, pain is not abating much for me. While certainly the scores have come down and I have improved some, gradually, from a functional standpoint and my ability to tolerate sitting/standing gradually a bit longer... the pain is otherwise the same. The goal/desire within the next 2-4 weeks is to be able to lower my daily dose of pain meds. While some basic strides have been made by me to reduce it by 1/4 of where it ultimately needs to be, I feel a responsibility/promise to my pain provider that we mutually agreed that this escalated dosing was only temporary. What ensued from surgery 3-10 was... well, more surgeries - and along with that, increasingly more painful infection and surgical procedures as things progressed. I know she doesn't necessarily mind/blame me for this situation being entirely out of my control and she not only trusts, but moreover respects me, I still intend on following through with that. I just hope that with more healing that goal will be more of a reality and also that she will be patient as I attempt to pull-back the meds as I'm able. Again, I would voluntarily pull back the meds, then to be forcefully told they are being pulled back. I will say, just like with any interactions with a good specialist, it's got to be a compromise of give and take on both ends. I'm just so grateful to have such a wonderful pain PA (and MD anesthesiologist doctor, whom I see maybe twice a year, at most) that focus fully on treating the patient and providing it in such a dignified/non-judgmental way. Again, generally speaking my experience at UCHealth was good, but the pain management department sucks so bad... my pain specialist is a separate practice I have been seeing for the past couple years has been truly amazing to me. Ultimately, this all sort of started even before it had become apparent that my chronic health issues, of the past 7 years, may have been the result of sub-acute infection. This ultimately something made of dreams, but I hold out hope and many of those who love and care about me and know just how bad things had been for these past seven years can attest, it would be truly beautiful if I was cured as a result of the sacrifices, trials and tribulations endured of the course of these 19 months. Only time will tell an hopefully given all the damage, there will still be plenty of gains ahead to the point that maybe... just maybe, I'll be feeling alive and human again.

Much love and peace. ~Z