Getting Healthy in San Diego one bone at a time!

Sunday, June 28th — Well, it’s been another month since I posted, and I’m sorry. Two of those weeks I was away in Massachusetts, minus a computer.  But again, I’ll just have to hit the highlights for you — it’s been a mighty full month for me.

Class of 1959 Radcliffe/Harvard Reunion

Attending my 50th reunion was my official reason for making the transcontinental trip at a time when I probably should have stayed home and continued my three-times-weekly visits to the Wound Care Center. But my TRUE reason for going was to spend a couple of weeks with my daughter Sarah, her excellent husband Christopher, and my two small grandsons, Johnston (5.5) and Hayes (turning 3 in July). A year between visits when children are young is way too much!

You may not know that Radcliffe College was a liberal arts college for women, incorporated in 1879, and the “coordinate college” with Harvard University. I say “was” because in 1963, graduates of both colleges began receiving joint Radcliffe/Harvard diplomas; and in 1999, Harvard swallowed up Radcliffe entirely. Both men and women now attend Harvard; Radcliffe is no more, except as the Radcliffe Institute, a specialized post-graduate study program that uses Radcliffe’s buildings.  (The dorms are now part of the Harvard “house” system. They’ve been co-ed for a long time. But not for 50 years.)

When I was at Radcliffe, all my classes but one were held AT Harvard (just a mile’s walk up the brick sidewalks along Garden Street in Cambridge), WITH Harvard professors, and WITH Harvard students in attendance as well.The one class that was actually held at Radcliffe was Physical Education, with such unforgettable offerings as Fencing, Archery, Bowling, and Body Mechanics, as well as the usual Volleyball and various other sporty-type activities.  In all respects, I received the same education as the Harvard students, and was graded on the same scale by the same professors. I loved most of my courses, with the notable exceptions of Physical Education and a Statistics course I stumbled into by mistake.  I worked hard, learned an enormous amount, married one of the Teaching Assistants in the Spanish Department three months before my graduation, and do not now recall EVER having felt “disenfranchised” by being a female student.

That was the buzz word, however, among many of my classmates at our 50th reunion. There was a lot of talk about how we had been given short shrift in one way or another, discriminated against in favor of the young men with whom we attended classes. There was probably even more such chatter than I heard, since I took part in very few of the events (mostly lunches and dinners) and skipped the symposia, which were doubtless very interesting and worthwhile. Truthfully, I felt more “disenfranchised” at the reunion than I ever did as a student. The Harvards who were reuning got lovely crimson tote bags; the Radcliffes got a manila envelope with our name badges, event schedules, list of attendees and their “maiden names” (ugh!), and a bright orange sheet about swine flu and what to do if we thought we were coming down with it. Now, that’s discrimination, I do believe.

That’s enough about the reunion, except to say it’s a weird experience to look at some old geezer or elderly lady in a cardigan and sensible shoes and realize who that person used to be. Even stumping along with my cane, with my ongoing leg problems — I’m not doing so badly, all things considered. It could be a lot worse. I’m glad I attended.

The Grandma Game

Wonderful days with Sarah and her family! I always come away from seeing Sarah full of inspiration: she is incredibly organized (her kitchen junk drawer is tidy and clearly arranged! her spices are alphabetized! her cookbooks have lists on the front covers of favorite recipes and the pages on which they can be found!) — and she is astonishingly creative.  I loved the way they just let me slide into their busy daily life and become part of it for two weeks. The boys are full of energy, sunny most of the time with a few sudden thunderstorms that quickly pass. Sarah and I went to see Star Trek, and loved it.

I got to sit in on some “play dates” that left me feeling like an anthropologist observing a strange new culture, the natives of which fortunately spoke English. On a play date, the mommies sit and drink coffee and eat yummy little things that somebody baked, and talk about the teachers. The kids run madly around the yard, shrieking with glee, swinging and sliding and digging and chasing. Every few minutes an Intervention is called for. One mommy dashes over to her child and says something like, “Tell me what happened before he hit you,” or “What were you doing before she put mud in your mouth?” The crisis is averted, no one is bleeding; somebody has to go indoors to the bathroom; somebody locks the back door from the inside, and somebody else has to be persuaded to unlock it… I was exhausted. How do they do it? How in the world did I do it forty years ago?

Sarah very kindly, expertly, and graciously changed the goopy dressings on my leg each day. I hated having to ask her; but I guess leg goop held no disgust for her, since she just finished toilet-training a two-year-old boy.

Leg Update

You may remember that I received an Apligraf skin graft just before I flew off to Massachusetts. Two days after I returned to San Diego, I went to the Wound Care Center, expecting that when the special covering over the Apligraf was removed for the first time, everything would be coming along nicely.

Yeah, right.

Apparently my body was so enthusiastic about its six weeks with the Wound-Vac, during which it was encouraged to Make New Tissue and Fill In the Pit, that — even with the Wound-Vac removed — part of it continued forming new tissue in the wound area. So when the covering came off, there was a neat little mesa of new flesh about the size of a silver dollar, rising above the surface of the leg. They called it “hypergranulation,” but whatever its name, it meant that the Apligraf had not “taken” properly and had to be removed.

I was rather disheartened by this; and not at all happy that the hypergranulated area (oh, let’s just call it “the mesa”) would have to be reduced by (1) scrubbing hard with gauze pads, and (2) several applications of silver nitrate, to burn it down chemically. But the Good News was that Medicare will cover up to FIVE of these skin grafts. That must mean that it’s not uncommon for it not to work on the first try. The last week has been spent doing everything we could to take the Mesa down to just below skin level. As of Friday, it was looking really good. My little team of experts are planning to put on a new Apligraf on Monday, tomorrow. And then I guess we’re back to a couple of weeks of changing goopy dressings while the collagen part of the graft settles in, and the other part begins to Become Betsy.

I am still excited and enthusiastic about the opportunity to have one of these grafts, and I’m determined that it will work this time. The Leg and I have been having some serious conversations, during which I remind The Leg that if it ever wants to be nice and whole and normal again, this is our best chance. It needs to cooperate by curbing its enthusiasm for growing upward, and channeling it into welcoming the graft as part of itself.

I’ll let you know how we progress, the Leg and I.

Thanks for reading — Betsy

Saturday, May 23rd — Yesterday began what I hope and expect will be the last stage of this long problem with my leg infection. Now that it is officially uninfected, and instead classed as a venous leg ulcer, I was eligible to be a candidate for a new and amazing product called APLIGRAF. I described this pretty fully in the last post, so I won’t go over it again.

Apligraf is  intended especially for use with venous leg ulcers like mine, as well as for diabetic foot ulcers. Both of these conditions are very slow-healing and painful. By placing the Apligraf skin on top of the ulcer, once it’s been debrided properly, healing of the ulcer is encouraged and the graft becomes one with the skin bordering the wound.

So there I was, with my pants leg rolled up, the center of attention of five physical therapists (one of whom was my very own Emily, who has followed this wound and cared for it three times a week since the start), including Stacy, otherwise known as The Maggot Lady. A representative from the company that makes Apligraf (Organogenesis) was there to oversee the procedure and offer helpful hints along the way. Apparently this was only the second time they had had a patient at the Mercy clinic who was “suitable” for this product.

It came in a very large box, which turned out to be full of Styrofoam packing and possibly refrigeration — I didn’t get that close a look at the packaging, but it would seem reasonable to refrigerate this stuff. The actual container looked like my hummingbird feeder: a clear plastic, circular dish whose top came off. Inside was what looked exactly like a round piece of SKIN. Apligraf is similar to human skin in that it has two layers — a dermal layer and an epidermal layer. It is dissimilar in that it has no sweat glands, hair follicles, or blood vessels. It was a neutral, Caucasian-hued piece of skin — but one of my favorite things about this stuff is that it has the property of repigmentation. That is, once applied, after several weeks it will take on the coloration of the surrounding skin. Thus, even in a person of color, eventually there will be no demarcation between the graft and the rest of the person’s skin! Isn’t that astounding? I love it! Just another instance of how it grows to become one with the recipient…

Emily had to tweeze out a few bits of hypergranulated tissue, since the Wound-Vac had done such a superb job of growing new tissue in the wound. In a few places, the new stuff had grown just a tiny bit above surface level. The skin wouldn’t adhere well if the base was lumpy, so to speak, so that had to be tweezed, swabbed with silver nitrate (which, in effect, burned the extra bits), and then scrubbed off.  I popped another Norco and felt better. Then she washed off the surrounding area, and we were ready to roll.

First she placed a piece of gauze, wetted with saline, over the graft, covering the epidermal side. Then she picked the gauze and the graft up with large tweezers — “Don’t worry about hurting it, it’s really tough stuff, just grab hold of it!” advised Angela, the company rep — and flipped it over into the top of the container. Now the underside, the dermal side, was facing up. Next she picked it up by the gauze-covered edge and flipped it again, this time onto the wound.  She removed the gauze with the tweezers and smoothed out the skin with the backside of the tweezers and a gloved finger. The piece of Apligraf was just a little bigger all around than my wound had been.

Emily placed Steri-Strips in a rectangular “frame” on the edges of the Apligraf, to hold it in place. An absorbent foam dressing was put on top of it and Steri-stripped down as well. Angela instructed me, “You’re never to lift this up. Don’t peek at the skin! You can change the dressings every day or two above this level, whenever you notice drainage; but DO NOT remove this part. When you come back here in a couple of weeks, after you return from Boston, Emily will take it off and check to make sure everything is okay.”

(I forgot to mention that I am flying away to Boston on Thursday, to spend 12 days with my daughter, her husband, and the two little grandboys — and to attend a bit of my 50th Harvard/Radcliffe reunion! The timing really was pretty good, what with winding up the Wound-Vac and applying the Apligraf and all.)

More absorbent padding and some of that self-adhering gauze bandage wrap finished the dressing. Then came the footless jersey stocking that goes under the Circ-Aid, the Velcro octopus that encircles my calf and provides compression. And finally, the Circ-Aid itself, to top off the whole concoction.

The Circ-Aid, by the way, is quite comfortable, and rather amazing in its own right. It’s based on The Giraffe! The giraffe has those spindly little legs that look like deer-legs, and he’s on his feet 24/7, since giraffes sleep standing up. Why doesn’t he have all kinds of lymphatic problems? Why doesn’t he have circulatory problems? We get them when we’re on our feet too long, or sitting down for long periods of time — why not the giraffe? Answer: because the skin on the giraffe’s legs is not elastic! Somebody observed this, and was inspired to create the Circ-Aid, which also provides circular leg compression with non-elastic material!

So I am ready to go to Boston. My daughter will help me with winding up my leg in bandages and putting on the Circ-Aid… but apart from that, we are going to have a lot of fun. I haven’t seen her or the kids for a whole year, since my birthday party in Toronto last Memorial Day weekend. Hayes will be three in July, and Johnston will be six in November. I can’t wait! My son-in-law, Chris, has already planned to babysit one night so that Sarah and I can go see the new Star Trek movie together. That’s one of the myriad reasons I adore Chris.

I’ll report to you when I return. I have one more session with David Klein on Wednesday, to get my spine ready for the trip. I’m so glad I will probably be able to resume my three-times-a-week at Seaside when I get back. The Skin and the Circ-Aid won’t need to go to the clinic as often as the Wound-Vac did; maybe I can manage with once weekly. We shall see.

Up, up and away… thanks for reading — Betsy

Friday, May 15th — Oh, good grief! I can’t believe it’s a month since I posted on my blog! And what a month it has been: I’ll have to summarize for you.

THE GOOD:

The Wound-Vac

Today was my final day with the Wound-Vac! And that’s very good. I really can hardly believe what a great job it did with my wound over the past six weeks or so. Every Monday, Wednesday, and Friday I went to the clinic where Emily and her cohorts would remove the compression bandage and the special sponge, clean up the battle site where necessary (tweezers! MIST! water squirts! more tweezers! AAARRRGGH!), and cut a new sponge to size, to set me up for another couple of days. I could see progress almost every time. The sponge pieces were getting smaller; the floor of the pit was rising…

When the maggots departed, the wound site was about three inches by two and a half inches, with a couple of half-inch “peninsulas” sticking out one side. The peninsulas closed up first. With the granulation initiated by the Wound-Vac, their floor rose to surface level, and then the sides closed in and skin grew over the top. GONE!

Just a couple of weeks ago, the part that was still open was the size of a Reese’s Peanut Butter Cup. Last Monday, it was the size of a quarter. Today — the floor of the entire wound was at surface level, and in a couple of spots, there was even a little hypergranulation: the new tissue was a bit above the level. It was the perfect day to cease and desist with the machine.

I do want to note that my cats, Amy (29) and Chloe (10), had totally different reactions to the machine that apparently had become part of me. When I was in bed, I’d just lay it down beside me, where it would tick and slurp and sloosh away all night. Amy slept with me a few times, less than usual; and always at arm’s length from the Wound-Vac. She eyed it with definite suspicion. Chloe, on the other hand, seemed to love it. She’d position her fat little self so she could “play the piano” on my hip — that kneading motion of the front paws, in and out, back and forth, that kittens use when they’re nursing, and grown cats revisit in moments of happiness and sleepy comfort. And her side, or her backside, would be right up against the Wound-Vac! It occurred to me that she might have perceived its rhythmic ticking as a heartbeat, or maybe a purr. Anyway, she liked it. I saw more of Chloe as a roommate than I had for months, while the Wound-Vac lay on the bed.

Chiropractic and Yoga

Both of these were cut back drastically during the past six or seven weeks, alas. I’ve only just started up with yoga/physical therapy again once a week, instead of the usual twice. And I was only able to get to Seaside Chiropractic one single time per week, most weeks. But the amazing thing is, while I wasn’t noticing improvements per se with chiropractic, I began to understand why Dr. Klein keeps patients on once-a-week maintenance adjustments once they’ve pretty well reached their maximum level of improvement. If I missed a week, I really knew it the next week: everything was out of kilter, somehow. For a while, attached to the Wound-Vac, I had to get my adjustments in a sitting position, as when I first began at Seaside a year ago. The last couple of weeks I’ve been back on the moving table, having first disconnected myself from the machine for the few minutes an adjustment takes. Now that I’m Vac-less, I’m hoping to be able to go twice a week — if my visits to the clinic don’t have to be as frequent.

The Next Step: New Skin!

Here’s the best thing of all: next week, I’ll be getting (1) a Circ-Aid, an octopus-like creation of Velcro straps that wraps around the leg from knee to ankle and provides compression; and (2) NEW SKIN OVER THE WOUND!

The Circ-Aid will, I guess, be part of my life for a good long while. It appears that I have venous insufficiency, a condition where the veins in the leg are hypertensive, and have higher pressure than the arteries. This means that they can’t pump fluids back toward the heart efficiently. Blood and other fluids may pool in the lower leg and cause swelling, as well as degradation of the skin (leading to ulcers). But you never know: when I get back to my regular thrice-a-week schedule of chiropractic with David Klein, miracles may happen in the venous department. After all, he’s pulled off a few miracles for me already. I’m willing to give it a shot.

But the New Skin is something altogether amazing! Its website (www.apligraf.com) describes it like this: “Apligraf® is a unique, advanced biological skin repair therapy, and is created from biological ingredients found in healthy human skin. Which explains why it looks like a thin, circular piece of real skin.”  Although it doesn’t contain sweat glands, hair follicles, or blood vessels, it does have fresh cells, proteins, and nutrients to get the healing cycle going. No staples or sutures, either; they just lay it on the wound, put some SteriStrips along the edge, and let it sit there for a couple of weeks, under dressings and compression. It grows right into the person’s own skin and becomes part of it. Even more amazing: it has the property of repigmentation, which means that, over time, it will assume whatever color the rest of the person’s skin has! Isn’t that cool? I can’t wait to be part of this — or have it part of me.

THE SAD

My next-younger sister died in Ann Arbor, Michigan, on April 29th, after living with cancer for nearly three years. She went into Hospice a couple of weeks earlier, and there was a sort of gathering-of-the-family to see her. I was not permitted to travel, given that I was still in the midst of the Wound-Vac treatment and needed to be at the clinic three times a week without fail to change the sponge. It wasn’t a good feeling, and it wasn’t easy to explain to her daughter and son why I wasn’t flying northward. Debby and I did have a good, brief conversation by phone a few days before she died, while she was still lucid.

I wish… I wish a lot of things, around this event. I wish I had been more loving to her, when we were children and teenagers. We were not always friends, throughout our lives; we were very, very different in our approach to life, and sometimes had small patience with each other. I wish I had been more understanding of her difficulties later in life. I wish she hadn’t been quite such a know-it-all about everything. And I wish she hadn’t allowed herself to be nasty and mean to our youngest sister, who went twice from Toronto to be with her. I kind of thought that a deathbed was your last chance to heal wounds and be loving to those you really love. Didn’t work that way, this time. It doesn’t matter now to Debby, but it sure does matter to Sally, who is left with that as her last memory of a sister she always truly loved and supported.

I think that’s plenty of Sad for now.

THE UGLY

Well, that would be me… at least, temporarily, I hope. Two weeks ago tonight I fell on my face; yup, flat-out on my face. I was wearing my glasses, so I ended up with huge glasses-shaped black bruises, as well as bruises on the side of my nose where the glasses’ little nose pieces went. Thank God I didn’t break my nose (although it bled like a waterfall, all over Robert’s mother’s favorite Oriental rug in the family room, alas); and thank God I didn’t break the Wound-Vac, which was, of course, slung over my shoulder. Hey, THAT would have been a disaster!

This was a fall that wouldn’t have happened, if I hadn’t lost some of my strength and some of my balance since the leg infection took over. Many times a day, in the real world, people stumble or trip minutely, and right themselves easily, without even thinking about it. I used to do that, too. Hopefully, I will again one day.

Meanwhile, I look like a raccoon. The black has faded to purple and lime-green, and has drained down from the eye area over my cheeks. An observer might suspect that the Beloved Spouse had been whacking me around, were it not that he himself had fallen out of bed a few nights earlier and broken a rib. Yes, it’s true. His side and my face were tastefully color-matched for quite a while. One of the physical therapists at the clinic whom I hadn’t seen for a week or so asked me last Monday if I had had a rhinoplasty (aka nose job). I said NO, quite indignantly. If I had, I would be extremely dissatisfied with the results; I’ve never been very fond of my nose.

THE END

Well, I guess that’s about enough for one evening. Hard to cover a whole month in a page or two! I hope you haven’t been bored to tears. For me, it’s been kind of a crazy month — lots of emotion, a fair bit of physical pain and discomfort, some really exciting developments. Thanks for reading about it — Betsy

Tuesday, April 14, 2009 — It’ll be a week tomorrow since they put the Wound-Vac on, and I have to say, it’s been a better week, overall, than the previous one.

When I left you last Wednesday night (or early Thursday morning, to be more precise), I was awash in pain from the newly-applied Wound-Vac. I’ve had two dressing changes since then, Friday and Monday. Both times, it’s very tough the night of the treatment: burning, aching, throbbing, pretty much all night. (Or, as I remarked Monday, trying to keep my mind off what was happening in my southwest corner — “Reminds me of Throbbie Burns, the famous Scottish poet!”) But most of the next day it’s increasingly better; some pain the second night; all pretty good the third day, but then I have it done all over again.

Visible Improvement!

What is remarkable, though, is that it is making visible improvement! The floor of the crater in my leg appears to be rising, the walls appear to be moving in just a little bit. Yesterday Emily said it looked “terrific.” To me, it looked like hamburger, and I said so; but apparently, what they’re looking for is “that red beefy look.” Ugh! More red, less yellow and gray = good.

Changing the Canister: Yikes!

Sunday night I had to change the plastic canister in the machine myself. That was a bit scary! It’s actually quite an easy business: the tissue that is suctioned up through the sponge and passes through the clear tubes is bloody, but it attaches to the gel that’s contained in the canister. Therefore, the material in the canister is reddish, but gel-like in consistency, instead of sloshing liquidly around in there. When the canister is perceived by the machine to be full, an alarm goes off (beep-beep-beep, not clang-clang-clang) and the little computer screen flashes “CHANGE CANISTER NOW”.

This happened around 6:00 p.m. I opened the zippered compartment wherein sits the canister; it didn’t look particularly full. I would have guessed 1/3 to 1/2 full. But the alarm was beeping and the order was flashing, so I scrambled around looking for a new, sterile canister pack in the several cartons-within-a-huge-carton that contain my supplies. The canister box was, of course, in the bottom. The change went off without mishap — it’s just snap it off, snap the new one in, throw the old one away. I was surprised there were no special instructions for disposal. Apparently it’s okay to just toss it in the trash.

Good Features of the Wound-Vac

So, after a week’s experience, there are definitely some things I like about this process and some things I dislike very much. Here are the positives:

• It does the job quickly, efficiently, and relatively painlessly.
• It’s possible to carry out most daily activities while wearing the shoulder pack, even though it’s pretty inconvenient. I can drive, for example, and cook, and feed the cats. To work at my desktop, I take off the shoulder pack and put it on the floor.
• It’s not uncomfortable to sleep with it. I plug it into the special battery charger and place it beside me on the bed. I thought the cats would hate it, but they don’t even seem to notice it.
• It doesn’t make a lot of machine-like noise. It does, however, make a rather nasty slurping sound every so often, as it pulls the bloody goosh up the tubes. Several times I’ve been about to make a snide remark at a cat or the Beloved Spouse, based on this sound and what I thought might have just taken place; but I’ve been wrong each time.
• I am allowed to interrupt the suction therapy a maximum of two hours a day. That’s a lot more than I need, really.

Not-So-Good Features

And here are the negatives:

• It weighs about 4.5 pounds, which is a lot for sore shoulders to tote around. I’ve taken to wearing the strap cross-body, messenger-style. Not much of a fashion statement, but it’s much less uncomfortable.
• Although the computer screen does have a screen-protect button to prevent screen settings from being changed inadvertently, it is not well protected by the flap that covers it. Several times a day, I find that the “THERAPY IS OFF” or that the Screen-Protect has been removed, simply because a touch or two on the flap has changed things.
• To take a shower, I have to: (a) turn off the machine;  (b) clamp off both tubes and disconnect the connector; (c) wind the lower tube once around the leg and tape it to the skin, so I won’t step on the clamp; (d) encase the whole lower leg in a plastic garbage bag, tying the closures and taping all the way around with special tape, to prevent any water getting on the compression bandage; (e) keep the leg out of the way of the water, as much as possible, while performing my ablutions.
• The time allotted before the “THERAPY INACTIVE” alarm goes off is only ten minutes. Ten minutes is not nearly enough to carry out the above activities; so from ten minutes after the start until I’m in shape to reattach the connector, I have to listen to that annoying beep-beep-beep until I feel like smashing the machine.
• There is no good way to contain the clear plastic tubes inside the pack. This means that, even if I coil them up under the flap and stick down the Velcro, they will be drooping out within minutes. And this, in turn, means that all that bloody goosh that should be kept personal and private is on view for the whole world to see, as it makes its slow way from my leg up to the plastic canister. I really dislike this feature! In fact, I dislike it so much that I actually wrote a letter to the manufacturer today complaining about this and suggesting they simply add a strip of Velcro, or two, under the flap, so the patient could coil up the tubes and secure them by looping the Velcro strip through and sticking it at the top.

On the Way to Healing!

From all current indications, if things continue to improve at this rate, I’ll be Wound-Vac free in three or four weeks. Sounds like forever, but hey — a week’s already gone. You can get used to almost anything. I’m planning to go to Boston at the end of May, through the first week in June. The occasion is (ostensibly) my 50th Reunion at Radcliffe/Harvard; but the truth is, I want to spend some time with my daughter Sarah and her husband Chris, not to mention Johnston (5.5) and Hayes (almost 3), and this is a great excuse. They live just outside Boston, no more than spitting-distance from Cambridge. I would love to be able to go with just an ordinary gauze dressing on the leg. We shall see.

Thanks for reading — Betsy

Wednesday, April 8th — The compression bandage felt pretty good on my poor leg, at least compared to what it had undergone on Wednesday, Wednesday night, and part of Thursday, till I became a Maggot-Free Zone. Emily did some more picking and tweezing and sluicing, during which I talked fast and dug my fingernails into my knee to keep from whining. The rinsing with sterile water was again rather soothing, but I kept anticipating that it might hurt. Hence the fingernails-in-knee trick. After a while, Emily (assisted by Jenna this time) noticed a lot of bright-pink crescents in my right knee area, some of them just barely oozing. “What in the world are those?” she wondered, no doubt imagining some weird rosacea-like rash. “Just my way of not screeching in pain,” I replied. They did look rather unusual.

A Misty, Moisty Experience

This time Emily used something called, appropriately, “MIST.” It’s a small machine that sprays a fine mist of sterile water on the wound from pretty close down, and delivers ultrasound waves through the spray. The ultrasound apparently helps break up any remaining necrotic tissue, getting it ready for either another round of maggots or — preferably — a Wound-Vac. All I felt, however, was this nice cool mist of water. That’s my favorite treatment so far.

And then it was more gauze pads, and LOTS more compression bandages, and the trick with the sandal straps to make my suddenly-huge foot fit into the shoe. I got a mini-description of the Wound-Vac from Ryan, and it sounded pretty manageable. So I went off home fairly happy, and looking forward to a few weekend nights of rest without any Residents in my leg.

“Anybody Left In There? Hmmmm?”

By Sunday, however, I was wondering if perhaps they hadn’t overlooked a single feisty maggot when they were tweezing around in there. I had a mental picture of this enormous fellow, left all alone at the Buffet by his less fortunate compadres, just gorging himself silly on what necrotic tissue was left. I thought probably that when Emily took off the dressings on Monday, there was going to be a maggot the size of a piece of popcorn, just totally stupefied by all that overindulgence. As she was unwrapping my leg, I told her about the fantasy, and she remarked, “Oh, that couldn’t happen. He’d have suffocated by now; they can’t get air through layers of compression bandages.”  Oh, terrific: so I’m going to find a DEAD maggot the size of a piece of popcorn in my wound? Wonderful! I thought.

I cannot express my joy when not a single maggot of any size whatever, dead or alive, was revealed under the Silvercel.

So the verdict on Monday was a cautious “It seems to be making good progress. Most of the dead stuff is gone, and you can see some healthy flesh along the edges here and there. Let’s not do more maggots, since you had so much pain with them. Let’s order a Wound-Vac for you, and we’ll put it on for you and show you how to use it on Wednesday.”

A Treat for the Poor Neglected Shoulders!

I celebrated by stopping by Seaside Chiropractic on Tuesday and having Dr. Klein do a sitting-up adjustment of my spine and some work on my shoulders, the way we used to do it before I graduated to the Moving Tables. I tell you, I’d been getting all kinds of complaints from the shoulders, who were used to being the focus of attention up to recently. Now, all of a sudden, it was What are we, chopped liver? It’s been two weeks, and where’s our adjustment? What does a body part have to do around here to get some attention — grow an ulcer and get worms?? When is it OUR turn again?  They were very happy when we left Seaside. I was pretty happy too, because I really miss my three weekly sessions and how great they make me feel. And I love when Roseanna takes me into one of the offices for a Game Question, and then ends up asking me about my life instead. She is such a terrific listener, she could be a therapist with no problem.

By the way, David Klein and Roseanna are pretty well running the office on their own these days. Itha went back to school (for osteopathy) and Jenny left, so Mama Bear and Papa Bear are multitasking like I’ve never seen before. Hope neither of them has a breakdown any time soon.

Eau de Rot: It’ll Never Sell

Tuesday night, not only was the leg under the compression bandage starting to burn and ache again, but (and this worried me) there was a faint smell coming from under the bandage. I noticed it at night, under my freshly-washed and sweet-smelling comforters. It made me very uneasy, because I am one of those crazy-clean people who keep the body-lotion and fragrance companies in business. I do NOT want to go around smelling like a week-old corpse and have people edging politely away from me when they get too close.

When the dressings came off, sure enough, it was very rank. Emily wasn’t quite as happy this time as she was on Monday. I certainly hope this Wound-Vac thing will make a noticeable difference, and fast, too. While the maggots only debride the wound, that is, they clean away the dead tissue, the Wound-Vac does some debridement and also promotes healing in two ways: by drawing the edges of the wound together, and by suctioning tissue up through a special sponge place on the wounds. This encourages granulation, which is defined by MedicineNet as “That part of the healing process in which rough, pink tissue containing new connective tissue and capillaries forms around the edges of a wound. Granulation of a wound is normal and desirable.”  As a matter of fact, the surgeon, Dr. V., had mentioned using a Wound-Vac for a few weeks after the surgery (which was not performed).

Wound-Vac, Just Like It Sounds

Comprising the special sponge, which is cut to fit the wound and placed over or inside it; special plastic “drape,” or tape, that provides a vacuum-sealed closure around the sponge; a suction device on top of that, that will pull the leftover dead tissue up through the sponge; a clear flexible plastic tube through which the tissue will flow to a plastic canister, attached to the small machine that is carried in a shoulder pack. The whole thing is computer-controlled, and can be battery-operated for eight hours. After that, you have to charge it.

I’ve never seen so many tubes and wires on one machine. My poor Beloved Spouse was down on his knees for ages, trying to attach an adapter so we could plug it in near the bed. Presumably, when I have to get up in the night, I’ll just detach the cord temporarily. The pack with the machine in it weighs a couple of pounds, but it’s not unmanageable.

I’m hoping everything is going all right with this 24-hour suction business. I don’t feel the suction, but I do see the stuff moving up the clear tube to the canister. And unfortunately, I’m having enough pain with this that I can’t fall asleep. So what better to do at 1 a.m. than catch up on my blog?  Hmmmm?

If it’s still this painful tomorrow morning, I’ll call and make an appointment to see Emily tomorrow instead of Friday. There’s a sort of strange sense of deja vu here — just like last Wednesday night, when I knew something was wrong, and had to remove the maggots halfway through their work order. I hope this is a healthful, healing pain, and not a something’s-wrong-again pain.

I’ll let you know tomorrow. Thanks for reading, and thanks for being interested in this kind of stuff. Takes a strong stomach… they say the Golden Years are not for wimps, and I’m beginning to believe that! — Betsy

Sunday, April 5th — I called the Wound Care Center first thing on Thursday morning and left a message for Stacy, telling her about the Great Escape and asking her please to fit me in for an appointment as soon as she could. It wasn’t ten minutes before the receptionist called back and told me to come in at 11:00. Stacy, unfortunately, was off on Thursday and Friday; but Emily could take care of me. (She would have been the one to take the maggots off after 48 hours on Friday, anyway.)

They’ve Got to Go

Emily asked Ryan and Ashley to stand by on this one, and it’s a good thing. More than two hands were needed, and mine did not qualify. After removing the very soggy outer dressings and getting down to the Containment Hut, Emily noted that there were Escapees all over the place. It was easier to identify the exit now, since the lip of the Hut had raised up even more. “We’ll have to remove them,” said she. “There’s no way we can stick this down properly, and they’ll just get loose all over again.”

I was dismayed, because I felt somehow that I  had failed. But Emily explained what had happened. The maggots had simply produced so much more drainage than was usual that the Containment Field had, in effect, been pulled right off its moorings by the liquid building up inside. She and Ryan agreed  they had never seen so much drainage produced in only 24 hours.

Lining Up to Get Out!

“And hey, guys, come here and look at this! You won’t believe this: they’re lining up to get to the exit hole!” Ryan and Ashley pressed closer to get a better look, while I yelped, “Wait! Wait! I need to get my glasses! Somebody hand me my bag!” It was true. Most of the remaining maggots were clustered in a far corner of the Hut, but there was an actual line of them moving toward the opening in the opposite corner. Now, I won’t say they were moving in single file, nor were they marching or goose-stepping; but they were definitely heading for that hole.

“How can this be? ” I wondered. “I didn’t even know they had brains!”

Emily answered, “A maggot lives for only two things: one, to eat; and two, to Get Out.” So they hadn’t concocted a devious plot, they were just following the Natural Imperative of the species. At the same time, they were bringing themselves to the Final Incineration 24 hours earlier than anticipated. If they’d just stayed cool, they could’ve kept gorging themselves at the Best Buffet in Town for another whole day.

Water or Tweezers: I’ll Take Water Every Time!

Then ensued a rather soothing sluicing of the wound with sterile water, to remove as many as possible of the remaining maggots. My leg was placed over a red plastic BioWaste bag, and the water was poured over me and into the bag until nobody else was coming out. The bag was then tied up firmly and given to an assistant for delivery to Incineration.  But we weren’t done yet!

For the next fifteen minutes or so, both Ryan and Emily carefully picked out the more determined hangers-on with tweezers.  This was not pleasant. Not even a little bit. When I get nervous, or when I’m trying not to act like a wuss in a difficult situation, I tend to talk a lot, and rather faster than usual. It keeps my mind off what’s actually going on. Ryan was really good at keeping a fast conversation going while picking slowly and precisely at leftover maggots.

Once they were all gone, Emily examined the wound more closely. “They’ve actually done a really good job,” she said. “You can see that most of the yellowish tissue is gone, and there’s even some healthy-looking red stuff showing.” After further discussion with Ryan, and while she was binding me up again in lots and lots of gauze and another compression bandage, she said I was to come back on Saturday morning for a dressing change. They could decide then whether I’d benefit from another 48-hour course of maggots, or if there might be another way of achieving the same goal. “Boy, Stacy’s really gonna wish she hadn’t missed seeing this!” she said. And then — “Oh, jeez, I forgot to take a picture! She’ll kill me!” But she didn’t want to unwind all that compression bandage and start over, which was probably just as well.

End of Another Chapter…

So it was back to taking a shower with my leg in a plastic bag for me, till Saturday. And then there would be still more discussion, depending on how the wound looked then. My guess is that a final decision on the next step won’t be made until Stacy is back on Monday, since she is the Head Maggot Lady and all.

Who knew this was going to be such a complicated adventure? Silly me — I thought it would be, put the maggots on, wear them home, live my life painlessly for two days, get them taken off, and bingo! All would be well. Guess not… Thanks for reading — Betsy

Saturday, April 4th — You know that thing about how I was maybe going to feel a little pain toward the end of the 48-hour period? Excuse me, but that was total crap! By the time I was on the I-5 heading north for home, my lower leg was starting to burn. Early in the evening, as the Boarders continued to stuff themselves on the Betsy Buffet — and thus began to grow and grow — I started to feel the weirdest thing I’ve ever felt (besides the early experience of a baby moving inside me at around four months). The latter, however, was memorable because it was so wonderful. What I experienced on Wednesday night was not at all wonderful, but, I fear, will be memorable.

More than You Want to Know about How It Felt

I could feel a creepy-crawly feeling inside my leg. It made me want to scratch, or at least rub… but I couldn’t do that, because (Stacy had cautioned me) “these are living creatures, and you can’t put pressure on this area or they’ll be squashed.” It was not painful, but it was irritating and strange, and it went on and on and on…

Then, around 9:00 p.m., as I was getting ready for bed, I started feeling what I can only describe as “prolonged bee stings”. Not a bee was in sight, and these, again, were inside the leg, not coming from outside. I can’t account for these sensations, but my guess is that some of the little monsters may have been secreting their oh-so-special enzyme to liquefy the dead tissue right up close to a nerve; and it may have affected the nerve in some way. It was definitely a nerve-type feeling. When a hornet stings you, it’s instantaneous pain — you know you’ve been stung right away. This was like that, except it just… kept… going… ON!

A Certain Lack of Sympathy

I got about two hours of sleep, tops, Wednesday night. Most of the time I spent whining, whimpering, and occasionally actually crying. My poor cat got so fed up with my noises that she left in a huff and went off to sleep with my Beloved Spouse. The worst thing that happens to her there is that he snores loudly. He also sometimes sits on her tail when he comes back from the bathroom and is still half asleep; but she’s learned by experience, and now meows to warn him off. All the meowing she could work up wouldn’t have stopped my whining.

Gradual Discovery of the Getaway

And then, of course, I had to change the dressings about every three hours. That coincided nicely with my usual schedule of getting up to go to the bathroom, except now I had to turn on the light so I could change them properly. All was well with the first change: unwrap elastic gauze, remove soaked gauze pads from top of Containment Field, replace with new pile of gauze pads (taped at the sides so they’d stay in place long enough for me to do the wrapping part), wrap with new elastic gauze.

At the second change, I noticed a slight movement on the roof of the Containment Hut. I grabbed my reading glasses from the counter. Yes, it was true: there was a single maggot, making his wiggly way toward freedom. For someone who tries to respect all life, and often takes spiders outdoors when they are encountered in the bathroom, I took an unholy joy in SMOOSHING that little guy. I thought, Jeez, you’ve been giving me hell all night… take that! You deserve it! Sorry. Guess I’m not so enlightened after all.

At the third change, there were five or six wrigglers to be removed from the roof. And at the fourth change, maybe a dozen. This couldn’t be right! I looked really carefully to see if I could find where they were getting out, and found that the flat lip of the Containment Field, that was supposed to be taped tightly to the skin, had risen in one place. The exit was only perhaps a quarter of an inch long, but that was definitely the place. I tried to re-tape it with the Special Magic Tape they had given me, but you just try figuring out Sheet 1 and Sheet 2 at 4:00 a.m. when you haven’t slept all night. I ended up with layers of tape of various kinds, and a determination to go back to Mercy Hospital on Thursday.

And the saga will continue… tomorrow. Thanks for reading — Betsy

Friday, April 3rd – Well, I promised to get back to you “tomorrow,” but I didn’t quite make it. The goings-on the last couple of days have kept me pretty exhausted. Let me inform you.

“Application”

On Wednesday the first, I returned to Scripps Mercy Hospital for the “application” of maggots. (Don’t you love how they find non-threatening and ambiguous words for all kinds of things in the medical world? In this case, they are going to stick a package of 500 fly larvae into one’s open, raw, bleeding, infected flesh and close them up inside. “Application” is good enough, I guess.)

Before we got started, I asked Stacy if I could see the maggots. She produced a large plastic pill bottle, containing a tiny folded piece of fine-mesh gauze. “There they are,” she said. “They’re inside the gauze.” They had traveled from Orange County in gauze, in a pill bottle, in an incubator, via FedEx or UPS! I wondered how many were in there. Would you believe 250 to 500? “Well, each one is only the size of a dot made by a ball-point pen,” said Stacy. “Of course, they’ll grow a lot…” 

Setting the Table

This time there were two other physical therapists, Ryan and Emily, and a student, Ashley, in attendance. Everyone bent eagerly over my leg to watch the process. Stacy unwrapped my bandage and announced that the prospective feeding site looked pretty good. She “set the table,” so to speak, by “tracing the wound”. This involved taking a sheet of thin, flexible, flesh-colored  plastic, laying it gently over the treatment area (another euphemism), and drawing on it with a pen to indicate how big a hole needed to be cut. Stacy cut the hole and placed the piece of plastic on my leg, with the hole over the wound.

Next came something I’m sure has its own name, but I think of it as either the “Containment Field” or the “Containment Hut.” It’s made of thin, flexible, permeable plastic (so the bugs can breathe, don’tcha know), oval in shape and roughly the size of the hole in the previous sheet of plastic. It’s perhaps half an inch high. It looks very much like those molded plastic cups that hold Feta cheese at the grocery store — with a molded lip or edge that is supposed to fit flat against the skin.

But before she put the Hut in place, Stacy removed the gauze from the pill bottle and placed it right into the wound. My wound! on my leg! She said she was just going to leave the gauze too, “or they’d be all over the place in an instant.” Then, just before clapping the Containment Field over the top of the wound, she remarked to her colleagues, “Hey, look at them — they’re getting right down to business!” I really couldn’t stand to look at that point.

Containing the Prisoners

To hold the Containment Field in place and prevent a general exodus of prisoners, they had a strange and magical form of sticky plastic tape, not quite like any I’ve seen before. It was one of those deals where you had to pull Sheet 1 off, then put the tape down, then pull Sheet 2 off, in order to make the tape adhere. Stacy didn’t seem too comfortable with this odd product, and kept asking Ryan and Emily what to pull and where to put it. (Not too confidence-inspiring to the patient…) But eventually the edges of the Containment Hut were sealed down, and the maggots were apparently not quite believing their good luck in finding such a feast after their long and lonely trip in the pill bottle.

Oh, and By the Way…

Then Stacy packed several thick, absorbent gauze pads on top of the Hut and wrapped the whole business up with a stretchy gauze self-adherent bandage. She instructed me to change these dressings, down as far as the Containment Field, every two to five hours, or whenever “brownish wet drainage” seeped up through the top layer of bandage. “Keep an eye out for anything that looks unusual,” said she, ” and if there’s anything, go to the nearest ER right away.”

Unusual?? Meaning just WHAT? This whole thing was unusual in the extreme, at least to me! I pressed for a little more clarification. “Well, if you have to change the dressings every half hour, that’s unusual.Or if you notice bright red blood instead of brownish drainage: that would mean they’d found a blood vessel that had some dead tissue around it. You need to get attention for that right away.”

OR WHAT? Nobody had mentioned this possibility before. “Oh,” said Stacy, “and you may feel some pain, especially toward the end of the 48-hour period. You do have pain meds, don’t you?” Do I ever: I have plenty of Norco, much like Vicodin except containing a smaller proportion of Tylenol and more narcotic. In fact, it seemed like a good idea to pop one of those RIGHT NOW, just in case.

WHAT HAVE I DONE??

Unfortunately, it was just a little too late to change my mind. Just for reassurance, I asked Stacy how long she had been managing this Maggot Debridement Therapy program. “It’ll be two years in October,” she said. That seemed reasonable to me. I guess she really did know what she was doing.

“And how many cases have you had in that time?” I asked, expecting something like 60 or 70. There was a pause, then: “Fourteen,” said Stacy. “You’re the fifteenth.” Well, at least I wasn’t second. Or first.

I guess there are not hordes of people lining up to get a packet of maggots sealed into their limbs. I tried to keep in mind how much I did NOT want to have surgery. I remembered what my wonderful orthopedic surgeon, Dr. William Bugbee, had said to me when I confessed to having chiropractic adjustments three times a week: he took my hands, looked right into my eyes, and said, “I’m so happy for you! ANYTHING THAT KEEPS YOU OUT OF THE HANDS OF THE SURGEONS IS GOOD!”

The saga will continue… tomorrow.

Thanks for reading — Betsy

Tuesday, March 31st — I had an appointment with Stacy, the Maggot Lady, yesterday afternoon for “evaluation of the wound.” All morning I had been busy scurrying around Scripps Clinic and Scripps Green Hospital, first for a pre-operative and fairly thorough exam by my primary care physician, Dr. Sanjeev Shah; and then for an EKG, which is mandatory for any patient over 60 who’s having surgery. All this was just so that I’d be covered for surgery on Wednesday morning, April 1st, in the event that the maggot option didn’t pan out.

By noon on Monday, when I dashed into the house to grab some soup before dashing out again to go downtown to Scripps Mercy Hospital, I had completely psyched myself into wanting that Maggot Debridement Therapy more than anything. So many pro factors as opposed to surgery; so few con factors. In fact, I couldn’t really think of any cons except the EEEEWWW! factor.

There was a message on my voice mail from Stacy, saying “There’s a problem with Dr. V (the surgeon), so don’t come for the evaluation. I can’t see you without a prescription from him.” And here I was, happily thinking he was on board with it, since he said “he wouldn’t frown on MDT.” This was definitely a frown.

Stacy had talked to him in the morning, and he told her my wound was “inappropriate” for MDT. He said that the whole wound was covered by an area of thick, hard, fibrous eschar (which, according to Stacy, would make it hard for the maggots to get to the good part). So, no prescription.

Okay, I admit it, I got all trembly in the voice and shaky in the hands. I couldn’t believe he’d backtracked like that! Completely unprofessional and immature of me, but there it was. I begged and pleaded. I told her I had noticed that using Vaseline-impregnated gauze dressings next to the skin, since seeing Dr. V last week, seemed to have softened the crust, and even seemed to have moved it a little so that some raw flesh was showing around the bottom edge. We shot the breeze for a while, trying to figure out how to proceed next. I decided I’d talk with the surgeon in the morning, and if he still wouldn’t prescribe it, I’d turn to Dr. Shah. Dr. Shah had told me during the pre-op that he was “right behind me on this,” bless him.

(See, this is where the plot-thickener part comes in: it makes the story more interesting if there’s a problem that pops up suddenly, one that makes it difficult to achieve the main goal of the story. That’s how I try to see problems that pop up in my life — as plot-thickeners. Sometimes it helps. Sometimes it doesn’t.)

Now it all began to move very fast. I spoke to Dr. V this morning, told him about the softening-up of the crust, and learned that he would not be willing to prescribe the treatment because he thought there was no way it would work for me. He also said he would not do follow-up on an MDT treatment. “I don’t do maggots, I do surgery; I don’t do maggot follow-up, I do surgical follow-up,” said he. Couldn’t be clearer. He did suggest I ask Dr. Shah for a prescription. I told him I was canceling the Wednesday morning surgery, thanks for his help and consideration, and if MDT didn’t work, I might be back for surgery at a later time.

Dr. Shah faxed the prescription to Stacy. Stacy’s secretary called to make an appointment for 2:00 pm today for the evaluation. The Wound Care Center at Scripps Mercy is part of the Rehab Center, in the basement. When Stacy took me through to the area where she works, we walked through a room that really took me back to my three months in rehab after my last hip revision, in the winter of 2006-2007: Swiss balls of varying sizes, exercise machines, lots of massage tables, etc.  Stacy’s area is one of those little spaces defined with curtains, that looks sort of like an emergency room.

She examined the wound and said: “I agree completely with Dr. V that no healing is going to take place here until this crust is removed. But I disagree completely that surgery is the only method of accomplishing healing. I can remove this right now, very easily.” And she did. With a scalpel, very gently and slowly. It was completely painless, although I did clench up a bit in anticipation of pain that never came. She remarked that it was not at all fibrous underneath, and that — in fact — once it was off, I would be a perfect candidate for maggot debridement therapy!

She put a square of silver mesh on the now-open wound, for its anti-microbial and antibacterial properties, and because it encourages healing. Hey, live and learn! I never knew that about silver. This didn’t look at all like jewelry, just like gray gauze. Then she put some gauze pads on, and bound me up from foot to knee in a stretchy compression bandage. There was a moment of comic relief when we realized that my now-enormously-bandaged foot was never going to fit into my sandal unless she loosened the middle Velcro strap as far as it would go; and even then, it wasn’t enough. So she found a strip of Velcro in her supply cabinet, and simply lengthened the strap!

She was calling Orange County to order the maggots as I left. They will fly in tomorrow morning, and I will go to meet them at 1:30. This is really some adventure upon which I’ve decided to embark!

I did ask how long it took for these maggots to become flies, and was reassured to hear it was something like 72 hours. I will carry them around for only 48 hours. I guess I had some dim concern that they might undergo their metamorphosis inside my leg… I pictured something out of a horror movie, where I’d open my mouth and hordes of tiny flies would emerge, leaving me just a withered husk… I also asked what happens to the maggots after they are removed. Answer: they are incinerated. Well, at least they die happy. And one more fact I found out: these are really teeny-tiny maggots, only the size of a pinhead or less. After all, their parents are about the size of fruit flies, not of house flies. After they feast for 48 hours, that’s when they become the size of a grain of rice.

These are important things to know when you’re going to be hosting a bunch of these critters on your very own leg for two days and two nights. You want to know who you’re dealing with.

Okay, I’m off to bed. Maybe now I’ll get some sleep, now that it seems to be decided that I will be Debrided by Maggots.  Woo-hoo! I’ll tell you more tomorrow.

Thanks for reading — Betsy

Friday, March 27th — The infected area on my right shin didn’t respond fully to three courses of antibiotics. Some of the inflammation disappeared, of course. But there is still an area of eschar, or what we ordinary mortals would call “scab”, about the size of a business card, as well as a warm, red, puffy area. Also, I’m shedding my skin like a snake, all around the leg from the ankle to above the sore area. It’s pretty disgusting, overall.

So my doctor sent me for an x-ray and an MRI last week, just to “rule out” infection of the bone. Okay, it’s all good, no bone infection. Next, he sent me to the Wound Care Center in the same Scripps Clinic with which he’s associated. The surgeon looked it over and told me it would be necessary to remove the eschar and “debride” the whole thing — scrape off the top layer and let it start to heal all over again. He booked me for an outpatient surgery next week.

The good thing about outpatient surgery is that I won’t get general anesthetic; instead, I will be “heavily sedated,” with Valium and Versed (you know Versed? it’s the I-can’t-remember-anything-that-happened drug). The bad thing is that it’s supposed to take place at yet another Scripps Clinic, which can only be accessed by driving up the I-5 freeway a few exits’ worth. That would mean the Beloved Spouse would have to be the Designated Driver, and he does not drive the freeways any longer. I’m not at all happy about that possibility.

Another REALLY BAD THING is that after the surgery, I would have to spend most of my time lying around with my leg elevated for… I don’t know, two or three weeks, apparently. For sure, I wouldn’t be doing any yoga or having any chiropractic adjustments.

But this is good as an ace-in-the-hole plan.

Next, I went to Seaside Chiropractic last Wednesday, for a final adjustment before my enforced period of lying down with my leg up. Coincidentally (except I do not believe in coincidence), Dr. David Klein was all excited about something he had read online, about yet another branch of the Scripps hospital system, in downtown San Diego, whose Wound Care Center operates a Maggot Debridement Therapy (MDT) program.

MAGGOTS?? You got that right! Fly larvae… maggots… those squishy little guys you see on dead birds and roadkill. But it appears that the maggots in the Debridement Therapy program are the creme de la creme of Maggothood: they are raised in sterile conditions, or “farmed”, by a guy up the coast in Orange County.

David and I phoned the Wound Care Center and spoke to someone there, just gathering a little more information. Then when I got home, I called the surgeon’s office. I asked his nurse to inquire if he knew anything about MDT, and if so, what was his opinion on it. She called me back at the end of the day. He had said that “he does not personally use MDT because he doesn’t have the resources, but it is not something he would frown on.” Now, that sounds like a guarded OKAY to me!

The next day I spoke to the Wound Care Center downtown, to Stacy, the Maggot Lady. The upshot is that after my pre-op physical and my EKG on Monday, I have an appointment with Stacy to “evaluate the wound” and see if I would be a good candidate for MDT. She said: “They prefer the yellowish necrotic tissue; they don’t do so well with large areas of eschar.” I took that to mean, “So they don’t like the crust, but they do like the filling?” Hmmmmm… much like me with pumpkin pie. I can relate to that.

Now, the EEEEWWWW!  factor is pretty big here, I have to admit. The thought of deliberately “applying” maggots to my own dear leg is extremely disgusting, and a little scary. Stacy breezily told me that the maggots look like grains of rice; but from what I’ve recently read, after they’ve had their way with me for a couple of days, they will look more like plump and shiny little hominy grits. However, the HMMMM…? factor is getting stronger and stronger, the more I think about it.

The deal is: I could drive myself there and back; no sedation, no anesthetic; they “apply” the maggots to the wound, then bandage over them securely; and away I go, back home. I pick up my life as usual for 48 hours, then return to have the beasties removed. I gather that to do this, they simply flush them out with water. Then they put a dressing on, and refer me back to the surgeon for follow-up care. I still need to find out more about this, but I think it will involve dressings for a while, and possibly a graft, if necessary. I am hoping I won’t have to spend two weeks lying indolently around, as I would have with the surgery.

Another nice thing about maggots is that they work for cheap: the cost is probably half of what the surgery would be! They don’t get benefits or worker’s comp, they are neither salaried nor paid hourly. They work for their dinner, as it were. I don’t know what happens to them after the feast, but I’m going to find out. Maybe they just pass away in a blissful overstuffed dream. Or maybe they drown in the flushing-out process. I’ll ask the Maggot Lady.

It’s going to be a very interesting week for me, either way. At last something will be done about this really awful leg ulcer — such a surprise to me, something I had never anticipated! And I certainly NEVER anticipated voluntarily submitting to a host of maggots, at least not for the next few decades.

I shall keep you all apprised. At least, wish me luck: surgically or by dint of maggots, I’ll be on the mend in a few days.

Thanks for reading — Betsy