A Plot-Thickener: Maggot Update

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