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Foot Surgery, April 2011 Transplant Labs

April 22, 2011 2 comments

My kidney transplant has now temporarily taken a backseat to another chronic problem-my foot.

Within the last 2 months, I’ve had 2 bouts of foot and leg cellulitis (infection) that just wouldn’t clear up.  Due to the peripheral neuropathy (Charcot Marie Tooth disease) and a pressure point on the outside of my left foot from a protruding bone callus after a fracture from 15 years ago, I developed a pressure ulcer on the bottom of my foot.  It turns out that the cause of the cellulitis’ was an infection of the foot ulcer, which turned out to be a superficial infection (Osteomyelitis) on the 5th metatarsal (foot bone).
I had gone to my PCP for initial treatment, and he thought the infection was due to an open are of skin on my shin.  I was on Keflex, and it seemed to resolve, but within a day or 2 off of it, the infection was back.  I went in for 2 days of IV antibiotics (Ceftriaxone) to the clinic, and it didn’t really do much.  I had then gone to the Podiatrist, and he debrided the ulcer, noting that it was fairly deep, and was draining amber colored fluid. He switched my to Doxycycline, and it was 90% improved from Friday to Monday. He debrided it and then packed it, and it was back to where it was before within 2 days.  I was then sent to the Orthopaedic Surgeon, who immediately diagnosed it as Osteomyelitis, and planned surgery.  But first, I was casted, and made non-weight bearing until the surgery (10 days).

In addition to debridement of the infection, he felt that I would need some reconstructive surgery as well. He brought in a colleague, who felt that it should be a 2 stage procedure, so as to avoid infection of the reconstructive aspect of the surgery.  The surgeon (Dr. Cush), felt that I should get it all at the same time, to avoid pressure on the original site of infection.  I opted for a single stage surgery, but for a different reason. The Transplant Surgeons always told me to avoid unnecessary surgeries.  Dr. Cush assured me that the reconstruction would be away from the infection site.

So on Tuesday, I had debridement of the pressure ulcer and bone, removal of part of my 5th metatarsal, shaving down of the protruding bone callus, osteotomies (bone removal) of toes 1 and 2 along with placement of screws and plates to straighten them out, a screw (and maybe a plate-can’t remember) up into my heel, lenghthening of the Achilles Tendon, and transfer of the Peroneal Longus tendon to the Peroneal Brevus tendon to straighten out/strenghten my foot.

The pain (and nausea) after the surgery were severe; I didn’t have a PCA pump (patient controlled analgesia), and I think that would have made a difference).  By Wednesday, I was feeling better, although still on rather frequent Oxycodone and IV Morphine, and by Thursday, I was ready to go home.  I’m doing well now that I’m home. It’s difficult not being able to bear weight on my left foot at all. We take our 2 legs for granted until we can’t use them.  Getting out of a chair is not easy, nor are steps.  I’m fortunate that there is a device called a knee walker-much easier to get around than crutches.

I just received a call today from the surgeon’s office, and the culture grew out yeast.  So, I will now be on fluconazole for the next few weeks.

As for my labs, my creatinine is stable at 1.1-1.2 (it was 1.2 this week, but my hydration status wasn’t the best).  My BK virus is up slightly from last month to 7700 copies in my urine.

Till next month….