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Posts Tagged ‘pressure ulcer’

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….

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March 2010 BK Virus Update

March 29, 2010 Leave a comment

I had my monthly labs last week, and overall they were good.

My creatinine is still 1.2, my blood counts are stable (my hemoglobin will never be in the normal range due to my Thalassemia; it’s in the high 12 range), and my Prograf level is 8.2 (right at where the docs want it to be, although at the high end of normal)

The level of BK virus in my blood dropped a bit, from 800 copies to 500 copies. It’s obviously still a concern, as I’ve been off my CellCept since last Summer, and I still have BK virus in my blood and urine, but it’s a low level of virus.  I’ll discuss this with the Transplant Surgeon at my appt later this month, but I’m sure that if they were concerned, they would be more aggressive with this.

Despite the immunosuppression, I am able to stay free of most infections, despite working as a RN in Pediatrics.  It’s not the common infections that are worrisome though, such as colds and stomach viruses, but rather the opportunistic infections like fungal infections or unusual viral infections (such as BK virus).  But I don’t worry about those; whatever happens happens, and I just do my best to avoid the ones I can, and keep on keepin’ on.

The only remotely recurrent problem I have is with my sinuses, and even that isn’t too bad.  I take a nasal steroid daily, and that helps.  However, I end up on antibiotics once or twice a year.  I recently read a report that many sinus infections are of fungal origin, and not bacteria. Unfortunately, I can’t find the link to the article.  When I find the article,  I’ll post it to the comments below.

I have a new online friend (Nancy), who donated one of her kidneys to her father.  She’s a regular reader of my blog, and found me doing a search on BK virus.  Her father just had a kidney biopsy, and they found BK in his kidney.  He’s thankfully doing better; please send out your prayers and/or positive thoughts for him.

BK is becoming a hot topic in the Transplant Community, but not a lot is known about it.  I think we’ll be hearing more about it.  Knowledge is power, and we need to be aware of this issue to be better informed, so that if/when it happens, we can deal with it better.

My foot continues to be a small problem (pain every day), but I’m now able to go for my daily walk.  I feel better doing so, and the benefits of walking outweigh the daily pain.  I still have a small superficial pressure ulcer, but it’s not worsening.  I just have to monitor it, and if it worsens, I’ll be back to the Podiatrist.  Just a speed bump along the way….