Bug War I

Important Information – Yesterday’s post was entitled Exercise “Battle of the Bug”, it marked the start of the story in my battle with a serious knee infection. Although it had a lovely little ring to it, it didn’t seem quite right in hindsight. For me as an amateur writer this is a big thing to be covering. Because of my involvement with the Army Cadet Force, and the fact that this is more of a war than a battle, I’ve decided to change my writing style slightly over this period. To make it easier for me to write and to bring in some lightheartedness I’ve decided to write it with a military theme. I hope this change won’t put off any of my regular readers, please read a few posts to see if you like it. I’m sure the style will develop over the next few posts, I have an idea of how I hope it will come across I just hope I can pull it off.

By the time morning had arrived I was only just getting on top of the pain issue. It was a good job I’d managed to get some much needed beauty sleep while in recovery or I’d have been in an even worse state of sleep depravation.

The first team to arrive at the foot of my bed was the Orthopaedic Team. After seeing the type of pus that came from the wound that opened the night before I thought it was going to be quite bad in there, when I asked how bad it was they told me it was a mess. Some cartilage had worn away but nearly all the rest had been killed by the infection. I was also told the Cartilage – or another structure – on the bone was just peeling away in strips. They have cut the bone in preparation for the full replacement during stage two, which will save them some time but more importantly get rid of infected bone. They seemed happy that it was nice and clean in there now, which is what you want to be hearing. As the knee was in such a mess I was told I shouldn’t do anything for the first couple of days. This is because they want to give the soft tissue the best chance of healing right from the start, music to my ears, especially when the Physio came round. The two holes where the abscesses were are being left to heal by themselves, which unfortunately will leave even bigger scars. Not that that makes any difference really with the amount of scarring that’s already there!

Next through the door came the Infection Team. They told me the Orthopaedic Team managed to collect some good samples of deep soft tissue during the surgery. These will be analysed using various different methods to see what bacteria they can see and grow from them. Next they do sensitivity tests, different antibiotics are used on the bacteria to identify the most effective course of treatment to eliminate the enemy. In the meantime they started me on a course of strong general antibiotics, which means different ones at different times, strengths and speed given, but all of them are intravenous.

After no sleep and in pain I felt like crap, thankfully my next visitor was a lady from the Pain Team. Because of the amount of breakthrough medication I’d had through the night they started me on a PCA (Patient Controlled Analgesia) of OxyContin, a small dose that was available every 5 mins. To complement this I was still on the usual Paracetamol, Gabapentin, Amitriptyline, Oxycontin (slow release over 12 hrs) and laxatives, to counteract the side affect from the medication, especially anything Morphine based.

Because I’m going to be on long term intravenous antibiotics it’s impractical to use cannulas, as it can only remain in place for 3 days. My veins are becoming damaged from the constant use and they seem to be burying themselves deeper and deeper. This makes it harder for the the person trying to cannulate me and more painful for me as they keep hunting around trying different veins. Nearly everyone on the BIU (Bone Infection Unit) has a PICC line (peripherally inserted central catheters). A PICC line is a long, thin, flexible tube, it’s inserted into one of the large veins of the arm near the bend of the elbow. It’s then threaded into the vein until the tip sits in a large vein just above the heart.

You get people who tell you it’s painful, others that say it’s not and people who say it’s more uncomfortable or unpleasant than painful. I was more than happy I’d managed to avoided ever having to have one in the past and really wasn’t looking forward to having one inserted. There’s a male Nurse on the Ward who is PICC line trained, he came in with a mobile Ultrasound, sterile pack and a variety of other bits and bobs. He has a look with the Ultrasound to find the veins available and how good they are. As usual I can’t be bloody normal, apparently my veins are very thin and difficult to locate. In the end he identified a candidate and got everything set up as sterile as possible ready to begin. This sounds like a big build up and very dramatic, which it maybe, but the procedure itself is nowhere near as bad as I expected. To be honest the worst bit is the first bit, which is the local anaesthetic. No matter where you put it, local anaesthetic is always going to have that local anaesthetic style sting. It’s a good job the Nurse was not shy of a challenge, he tried 3 or 4 times to get the line in. He was using the Ultrasound often to ensure he was in the right place and also for tracking down different veins to try. Apart from using more local anaesthetic at the different attempt sites I didn’t really feel anything else. I was expecting to feel something as the line worked it’s was through the body but I didn’t feel a thing. For the vast majority of people it’s one go, and bingo, it’s in! I’d have no problem with having another one done, even though it was problematic for me, it’s really not that bad, it sounds a lot worse than it is.

Because the PICC line is near the heart I had to have an X-ray before it could be used, it turned out it needed to be pulled back two centimetres. Again the most painful part of that exercise was taking the dressing off to get the line in the correct place. It turned out to be a bit painful over the next few days, but that’s just the bruising from the various attempts to get it in. When they flush the line I find it cold as it goes around the exposed bit of line but nothing after that. When the antibiotic starts it’s just the same feeling as the flush, a few seconds of cold at the start and then nothing at all. A bit like an amputation everyone’s experiences of PICC lines will be different. If someone mentioned it to me before I had it done, it would conjure up images of possible pain and discomfort. Now if someone mentions it to me it doesn’t conjure up an unpleasant image anymore, it’s now just a procedure, like going for an ultrasound, X-ray, or giving blood.

There was a lot going on and a lot to take in that day, people, wires, machines, observations, more wires, information, stuff being pumped into me, stuff being drained off of me, even more wires, you get the picture. Despite the pain issues I was having, and you can never underestimate the power of pain on your body and mind, it was a reasonably positive day. This was mainly in the information area and what I was being told by the Consultants. If they’re sounding positive and happy then that gives me a bit of confidence too.

Even though there was some positivity taken from the day there are issues. These are the main issues we have at this time:-
We don’t fully know our enemy
Some of our kit and equipment may need to be changed
We have no idea how many battles we will be involved in
We don’t know where we will be based but are prepared to move to one or more locations

I use the term ‘we’ because I’m extremely lucky to have teams of people who are doing all they can to get me through this. Any surgery you have, no matter how major or minor, involves a huge team effort. My biggest bug bear are the people who forget that they are also part of that team. The people who expect all the medical professionals to do their part of the process and the person does nothing to help themselves. Although I have this massive team around me I’m fully aware that I have my own role and responsibility within that team as the patient.

We are at war.

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