Bed Rest: Day 21

Woke up sometime around 8 or 8:30, went back to sleep.

Awoke again at 10:30. Had breakfast: Cheerios and orange juice.

Watched No Country For Old Men. Good movie.

Ate lunch: peanut butter and honey sandwich, carrot sticks, Coke.

Afterwards, laid on my stomach for an hour or so till my neck started to hurt, might have dozed off again

Polished off October National Geographic: articles on right whales and Ozark Highlands National Recreation Trail

Internet till dinner, then probably TV: new South Park on tonight.

Getting A Little Work Done

A girl I briefly dated once told me I had, "No ass." As it turns out, the location of my oft-discussed pressure sore as evidence, I suppose she was right about that. After tomorrow though, in that spot, I will have less. And as a means to an end this will be a good thing.

Hey Hey, My MRI

This is how the pressure sore looked in September of last year. In this cross-sectional image, my legs projecting out towards the viewer, the sore is circled.

The next image is the condition of my sore in April of this year. Not much difference in the appearance, hence the necessity of the third surgery to clear out the last residual infection.

Over the summer I underwent daily hyperbaric oxygen treatments to help aid in healing this sore (and in conjunction watched a lot of shitty movies - I'm looking at you Mission: Impossible 3). While I can't confirm the extent to which these hyperbaric treatments contributed to curing the osteomyelitis that delayed the healing process for these many months, the wound responded to treatment in such a way this summer that the U of M plastic surgery team feels they can safely close my sore with a flap procedure.

Everyone's Favorite Substitute Anatomy Diagram, One More Time

A pressure sore forms because the blood circulation to the tissue covering a bony prominence becomes constricted and the tissue then deteriorates. When it was discussed with me last October that these sores often need to be closed surgically and that this was often accomplished with a flap procedure I was under the assumption this would be something similar to a face lift. An ass lift of sorts. I'm not going to pretend to know all what is involved in a face lift, but I do know that it entails stretching loose skin back to make it appear tighter, more youthful. Simply stretching the skin next to and over the cavity caused by the pressure sore will not rectify the problem of providing more cushioning over the ischial bone where the sore formed in the first place ("No ass," as stated previously). The gluteal rotation flap attempts to solve this problem by moving not only the skin but a portion of the gluteus maximus muscle over the depression caused by the sore. The procedure is more involved than the three debridements and biopsies that were previously performed and is expected to take two to three hours. I'm anticipating to end up with a scar that looks something like this:

(click to enlarge)

The convalescence period after this operation starts with at least three weeks of complete bed rest to allow the flap to take hold. After which point, if the drainage has subsided, I can start a sitting protocol regimen. I will begin with fifteen minutes of sitting three times a day. If there are no problems with bruising or lack of circulation, the sitting durations will be increased by fifteen minutes every couple of days. If all goes according to schedule it will be a six week recovery process.

And then I'll finally be able to get back to whatever it was I was planning to do last fall.

There Is A Light...

...at the end of the tunnel. The light is but a flicker, but it is there. I found out today that there is hope for a conclusion to the saga of the pressure sore coming in the form of a plastic surgery procedure. Finally.

The procedure is scheduled for September 17th. Why almost a whole month from now? Why not sooner? Because any sooner would be, well, convenient. And the U of M Plastic Surgery department isn't in the convenience business, they're in the Michigan Difference business! Or so I've been told.

Post surgery convalescence will be a stay of three to five days in the hospital followed by a scant six weeks of total bed rest. Wait, an additional six weeks? C'mon, what's six more weeks of lying around when you've already logged over fifty? I mean besides "the rest of September" and "October."

I suppose there is a chance this sore could heal on its own in the intervening month and I wouldn't need to have the surgery, but that would be way too...um?...ahh, what's the word?

Anyway, so there's a light somewhere down at the end of the tunnel.

I just hope it isn't a train.

That would suck.

Suck On That. Suck It Long, Suck It Har...at 80 mmHg

Time for something different. When I learned in March that I would need a third debridement and ischium biopsy peformed on my pressure sore, with the prospect of losing an entire summer on the couch, I wanted to know if there was a better way to end this predicament. Much to my frustration, my doctors at UM Plastic Surgery were more than satisfied with the way they felt my wound care had progressed. Yes there have been setbacks, but the problem up to this point has been a lingering myelitis bone infection deep in the wound that prevents the regrowth of tissue over the biopsied area of the ischium. If the wound doesn't heal from the inside out, it will never heal properly. In the view of my doctors at UM, they have pared down the area of infected bone and with this third ischiectomy and another course of IV antibiotics, they are confident this sore will finally heal as is it supposed to. When questioned whether or not there was anything I could do in addition to what we've already done, the answer was, “No, not really.” While they might be right in assuming that if they finally kill off the infection the wound will heal from the inside out and no further debridements will be necessary, they've also be wrong twice so far and I've lost eight months to this sore. I decided to look for other options. I'm now entrusting my wound care to the Wound Healing and Hyperbaric Center in Westland, MI, an extension of Garden City Hospital. My main reason for selecting the Wound Healing and Hyperbaric Center was the availability of hyperbaric oxygen treatment which is supposed to provide excellent support in healing all sorts of chronic wounds (more on that later). This is a therapy not offered by UM. An additional reason influencing the decision to work with the wound specialists in Westland is their willingness to try other wound treatment options. At UM, the extent of the suggested wound care regimen was twice-daily wet-to-dry dressing changes and after a course of antibiotic treatments application of the growth factor medication Regranex. Again, other treatment options were not suggested or recommended. At Westland, during my initial consultation, several treatment options that had been suggested to me by visiting home health nurses I've spoken to, but not favored by the doctors at UM Plastic Surgery, were discussed from the outset. One of those treatments is negative pressure therapy, also know as a wound vac. Negative pressure therapy uses suction to enhance the capacity of the wound to heal. The suction increases blood flow to the wound bed similar to the telltale signs of a junior high, hickey-inducing makeout session. The increased circulation brings much needed oxygen to the tissue critical to wound repair. In addition, the suction removes harmful waste drainage away from the wound site. With the waste drainage removed and increased blood flow to the wound bed the formation of granulation tissue is enhanced. The granulation tissue is the base layer on which skin cells can form. After increasing circulation and removing the excess fluid, there is also a diminished opportunity for harmful bacteria to take root in the wound. All of these characteristics of negative pressure therapy are encouraging when compared to the alternative of what I've been doing. Some of the research suggests that negative pressure therapy doesn't necessarily speed up the healing process, and I will have to carry around a small vacuum unit with conspicuous tubing running from my wound and out of the waistband of my pants. Even if the speed of the healing with he wound vac is negligible compared to more traditional methods, at this point it is worth a try.