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Oct 3rd 2022: Antibiotic Nail Removal Surgery

Hey everyone,

It has been quite a while since I've posted, or provided any of you an update (more on that later, in an upcoming blog post). For now, I wanted to post the details regarding my next surgery.

Let Femur Antibiotic Nail Removal

  • Date: 10/03/2022 (6:30AM check-in for an 8:30AM surgery start-time; surgery duration: 141 minutes)
  • Location: UCHealth Surgical Care - Anschutz Inpatient Pavilion (pre-surgery checkin 2E elevators)
  • This should hopefully be the final surgery (3 of 3 of the amputation series, 10th surgery in the infection series, and 17th surgery in total - since 2005 - on my left leg, alone). As has been the case with all other orthopedic surgeries before it, this procedure will involve induction of general anesthesia prior. After that has occurred, they will make a cut into my incision line and remove the antibiotic nail (roughly the total length of my residual limb - all the way to the hip) that was placed/replaced during the 8/18/2022 and 8/22/2022 surgeries, respectively. At this point in time, we don't expect that I'll be admitted to the orthopedic floor (or kept overnight); however, if pain upon awakening is untenable, or anything concerning occurs or is discovered during surgery, given my complicated case/course/history, I could totally see them admitting me for pain, or observation.

What's next

As far as what's next: presuming that this next procedure is unremarkable in course/recovery (in other words, there is not any further surgical complication, or infection), then I'll be on course to continue with vancomycin until I'm well enough to drive, or be driven to their outpatient infusion center. The plan, at that time, is to receive a dose of Dalbavancin (think 14.4 day half-life vancomycin). Since this is the first time I've received this particular antibiotic, I'll probably ask for them to hold off on pulling the PICC line for 15-30 minutes after the infusion is completed. I have developed exposure allergies to other antibiotics in the past two years. My most recent anaphylactic reaction (fortunately wasn't full-blown shock) occurred on 4/1/2021 in response to a cephalexin exposure allergy and subsequent inadvertent exposure, due to 'a major mess-up' on the part of my home injection pharmacy. While I have been tolerating the vancomycin very well, given the very long half-life of Dalbavancin. However, if for some reason I was to be allergic and I left too early, not only would being on the road be a dangerous thing (driving while having a very bad anaphylactic reaction - which happened last time), but moreover, given its very long half-life, while they cannot clear it from my system any faster, they could at least provide me IV medication, in the form antihistamine/benzodiazepine/etc. and if necessary oxygenate/intubate/protect my airway. That allergic reaction last time was quite scary. First off, I was alone, broke out into a cold-sweat, nausea, abdominal pain and noises, itchiness all over my arms and throat, burning in my hands, wheezing, etc. (not to mention I was unable to sleep for the next 3 days). Again, there is no indication that's going to be the case, but I'm going to be careful. I may even see if I can have family, or friend accompany me along for this infusion.

Barring no further complications, the focus next will be on walking

At that point going forward, I should then be done with my antibiotics. I formally have one additional appointment a week or so after my next surgery (one final time to check-in, before my contact with them falls back to - "only as needed basis"). Thus, if through this next surgery's recovery I experience anything concerning in the way of residual/continued infection, I will need to reach out to both infectious disease and the orthopedics team and we'll assess where we go next from there (in the event of chronic infection). Also next week, I will need to find time either on Tuesday/Wed to visit the UCHealth in Broomfield (a little closer to home) to get my weekly bloodwork done, which will offer us yet another data point. After this, presuming I'm free of further complications, in the months ahead I'll be focusing on work with my prosthetist and physical therapist.

What happened this past month to the updates you promised?

To round out the end of this blog post update, as promised, I wanted to provide a brief update into the happenings since my last hospitalization onward to present. In short: this amputation has been one of the most painful experiences, I think I can safely now say, the most painful experience of my life from a physical standpoint. There is so much I want/need to say when I provide this update. I really need to provide it in the backdrop into what happened in terms of my pain management (or lack thereof) coming out of that second surgery that found me leaving the hospital - at a lengthy - 3 weeks later. Additionally, while I had full intention when I got home to provide all of you an update on my blog, I was dealing both with technical problems with my linux server, coupled with a slew of other completely unnecessary complication with home health and getting my bloodwork done. Additionally, I had to be re-hospitalized for a night to have a new PICC line put in (since the former one had fallen out too far, and simultaneous concern that my PICC site was infected). That doesn't even begin to broach, even mere tangentially, on coping with life after limb lost. Everything is much harder, I'm very limited with what I can do (currently), and it's been hard (and sometimes felt impossible - up until now) to offer up the level of mental/emotionally-level headspace to provide you an honest update given that so much of my time, up until now, has been spent either dealing with physical pain (either in the form of phantom limb/residual limb), an unrelenting amount of doctor's appointments, let alone and not beginning to even touch on the ridiculous level that some providers put me through. For instance: home health messed up the first two weeks of attempts after leaving the hospital, which meant I had to figure out it was their fault, take steps to correct it (by getting bloodwork done at the hospital, etc.); likewise, in the hospital, even though I was raw and just coming out of my second (and somewhat even more painful surgery), the pain team instead of acknowledging I had just had my leg amputated, and had JUST come out of a second five-hour long surgery (along with the preceding 18 months and seven surgeries and that my pain was legit), took it upon themselves to take away the pain meds when they were needed the most. This literally spiraled me down into hell for the next 5-7 days. Then once I got home, I had been dealing with more of the phantom limb pain and general inability to get around very well. All things considered, I think I'm doing quite well. However, I have also been working very hard and I'm starting to feel sick and tired of being sick and tired and not sure how much more of this I can weather.

Therefore, it is my estimate (presuming this next surgery isn't as painful as the two preceding it), then I think I'll be better/more able-bodied to provide a more full write-up (or several blog posts) that brings things to current in the coming weeks. However, I will firstly need to prioritize health/pain/provider appointments, with looking into student loan forgiveness as a close second. I have been sleeping a lot. Thus, with any remaining time I have (beside visiting with friends/family), I plan to balance on providing some real updates here in the near future (especially as things get better - hopefully!) and all the while trying to balance the "need to" list with some "want to" list. Trust me w hen I tell you, I want to update you guys, it's just when you get so far behind, it is sometimes challenging on figuring out where to start.

Thanks in-advance for your love and prayers. I look forward to providing you some new, tangible updates, here really soon! Right now, I need to focus on getting ready to weather this next surgery. Feel free to call/text/email to check-in and I'll respond to you as soon as I'm able!