Category — 1

Saturday, January 30th, 2010 — Last week I had another re-exam at Seaside Chiropractic.

In March it will be two years since I made a commitment to ongoing chiropractic treatment with Dr. David Klein: two amazing years! For most of that time, with the exception of about six months during which I was toting around either

• 500 maggots embedded in my leg to clean out a large infected wound, or
• a 5-pound Wound-Vac on my shoulder –  a computerized gadget involving a suction cup and lots of plastic tubes, to encourage new tissue to form within the pit left by the Maggot Clean-Up Crew,

my re-exam charts showed a steady upward progress. It was dramatic at first, then leveled off a bit; but it was always upward, bit by bit.

Re-exams are given approximately every 12 visits. I used to have Dr. Klein’s team of sidekicks assist me in posting the graphs so I could share them with you. However, now that I’ve become such a longtime patient, the graph and its accompanying legend have to be so small to include everything that it’s hardly worth posting. I have to use my reading glasses AND a magnifying glass to get the whole picture.

So this most recent graph showed a few interesting changes. Once again my legs are “even”: for ages, the left leg would be an inch longer, then — abracadabra! — the RIGHT leg would be an inch longer. And then it would change again. Once, for several months, they were even, but it didn’t last. Now they are the same length again. No wonder I’m gimpy and walk with a cane!

It was a little discouraging, as I moved various parts of me in response to David Klein’s instructions, to keep hearing “restricted,” “restricted,” “restricted,” again and again, in reference to just about everything. But then, surprise! My right shoulder, which has been out of alignment since the beginning of my journey with chiropractic, is at last where it’s supposed to be. One of the original reasons for my setting out on this journey was to see if chiropractic could make enough difference in my arthritis-ruined shoulders that I could avoid having them replaced, as had been proposed by the surgeons. DK was pretty confident that he could restore an acceptable amount of range-of-motion, as well as reduce the pain to an acceptable level. I have to say, the shoulders still hurt a lot; but I can reach out to both sides, and I can reach up with both arms far enough to get the oatmeal box off the TOP SHELF. I can certainly live with that.  And now they are beginning to straighten out, as well.

So there’s a long way still to go; but the line on the graph connecting the dots between re-exams is creeping upward again, ever so slowly. I like “dramatic” better than “slowly,” but that probably isn’t a realistic expectation at this point. I will settle for any kind of upward I can get, with gratitude.

Thank you yet again, David, for your constant and dedicated attention to restoring this 72-year-old body to a level of functionality that will take some of those years away.

Onward and upward, then; and thanks for reading.  — Betsy

Saturday, January 9th —

My little cat was put to sleep at 3:00 pm yesterday. It was a terribly difficult day – but the procedure couldn’t have been more compassionate.

By Wednesday, it had become clear — we thought — that Amy was just getting too tired to fight it any more. Our Mobile Vet (www.drdoss.com) had told us to “look 24 to 48 hours ahead in making a decision; things move very quickly with cats.” So on Wednesday, I tearfully called and asked him to make an appointment for Friday.

Then, of course, all through Thursday I kept wondering if it was the right decision. Amy was outside under the bush on the slope when I went off to the chiropractor. When I got back an hour and a half later, she was on my bed: so she had been able to let herself in the cat-flap, make her way to my room, and jump up on the bed. Maybe it wasn’t time yet, after all…? But the vet assured me that he always examines a cat carefully, under mild sedation, before proceeding with euthanasia. He is a cat-lover himself, and doesn’t want to do anything prematurely.

I really love Dr. Doss, the Mobile Vet. He said right at the start that he would sedate her, using an agent that could be reversed if what he found led him to believe Amy could have a few more weeks of reasonably comfortable life. However, what he found was pretty much what we expected. There was a large tumor in the nasal cavity, pressing down on the hard palate and causing it to sag into the mouth. (I could see it clearly, when he opened her mouth and showed me.) One nostril was completely occluded by the tumor. That little cat was operating on only one nostril for the past few weeks! It astounds me to think she was still able to jump up on the bed, jump in and out of the cat-window, and everything else she did! What a tough cookie she was.

After the sedative came a painkiller, just in case; and finally, the injection that stopped her heart. It took a few minutes, during which I stroked her and murmured to her, and told her how much we loved her. I was crying like Niagara Falls all this time, of course. As I watched her little side go in… and out… and in… I saw it stop. I said, “That was it, right there, that moment, wasn’t it?” And Dr. Doss said, “Yes, it was.” He sniffed, and I caught him wiping his eyes, so I handed him the box of Kleenex, and he blew his nose. A real snorter! I patted him on the shoulder and (weepingly) told him I was really glad he cared enough about Amy to shed a tear for her. That’s what makes him different from other vets, to my mind.

I had Robert bring Chloe in so she could see that Amy was dead. She’ll miss her, after a while, and look for her, but it  was important for her to realize that Amy didn’t just go away. At this point, she is just delighted that finally we are letting her eat from Amy’s dishes, in Amy’s place; she’s been coveting that for years.

And then Dr. Doss put the little body – so very small! – into a plastic bag, very tenderly, to be delivered to the San Diego Pet Memorial outfit. They will cremate her individually and send us back her ashes in a little cedar chest with a plaque on top with her name. I think we will scatter some of Amy under our dwarf Meyer lemon tree on the slope, where she loved to sit in the sun; and under the bush at the top of the slope, where she spent much of her last weeks. The rest we’ll keep.

So that’s the end of the Amy era for me – eleven years. I cannot even imagine what it will be like to be without her: from the relentless alarm-clock-at-six-a.m. hollers for breakfast; to the daily argument about which of us was going to sit in my computer chair (she always won by pretending to be too soundly asleep to hear me asking her to move, and I always ended up moving the chair out of the way, with her in it,  and nabbing Robert’s chair so I could do my work); to the loving, trusting snuggles at night when she decided it was my turn to have her sleep with me. She was one wonderful companion.

Amy lived the last 11 of her 30 years with us. It took three years after we moved in here for her to trust us enough to come to the door for food twice a day; and  a month after that to trust us enough to come into the house. She was shy of things-like-sticks and things-that-rustled loudly (think umbrellas, canes, and plastic bags) for a long time. People had not been kind to Amy, it seems. At least, her first home had been one in which they loved her enough to have her spayed — otherwise, she never would have been able to survive when she was lost, or ditched, or strayed away.

She was one of those “talking cats” who tries to mimic human intonations, and really understands an astonishing amount of human conversation. You could have a very satisfying two-way chat with Amy on a variety of subjects, not only Food or Going Outdoors or Time for Bed.

Of all the many cats I’ve lived with and loved in my long life — there have been 18 of them — Amy was one of the most loving, expressive, and interesting. Watching her regain her comfort with relating to humans, after 16 or more years of living outdoors, on her own, was very touching. Once she decided to move in with us, Amy and I made a contract. I promised her that she would have the best Golden Years any cat could have, with human-quality cat food and half-and-half twice a day, and that we would love her forever. She promised, in return, that she would give us her love and her trust, and keep us as her family for the rest of her life.

We both kept our promises.

Thanks for reading — Betsy

Tuesday, September 8th –  The day after Labor Day, and all is well! Very well, in fact: thanks to Dr. Klein’s  expert attentions twice a week for the past couple of months, I am rapidly returning to the level of flexibility I had reached a year ago.

Let me backtrack a bit. On August 16th — six months to the day after I had The Fall that changed my life so much — I was discharged from the Wound Care center at Mercy Hospital. Post-maggots, post-Wound-Vac, post-a-whole-lot-of-trouble — and not to forget post-Apligraf — my cell-phone-sized wound was totally healed over. Sam the Skin had completely melted into ME, and I have now got a lovely new baby skin covering what used to be a horrendous pit.

The Bad Part: There goes my social life! After five months of going to Mercy Hospital three times a week, gee, what in the world am I going to do for fun? I find myself really missing seeing Emily and the gang of physical therapists who did so much for me, so caringly. I did write  a long letter to the Head of the Rehab Department, telling her how incredibly fine her staff is, and naming them all. I’m hoping that will filter down to them somehow, because they really are exceptionally good at what they do, and good people, too. I could have had a lot worse social life for five months, believe me!

The Good Part: Well, it’s mighty good to be wearing only that Velcro contraption, the Circ-Aid, and a jersey footless tube-sock, during the day. I do not miss the heavy dressings, and neither does my leg. I can’t tell you how blissful it was, that first night, with just me and my skin inside my pajama leg!

I seem to have lost sensation in the area around the wound; but that isn’t to be wondered at, since a whole lot of nerves were severed. Maybe some of them will grow back. Meanwhile, the skin over and around the wound doesn’t feel like human skin to my fingertips. It feels kind of like thin plastic. I’m supposed to rub Vitamin E into it twice a day, gently, to help the skin thicken. It will be extremely fragile for up to two years (TWO YEARS!! Oy!) and even when it gets as strong as it’s ever going to get, it’ll be only 80% of its original strength. But that doesn’t really faze me.

Another Bad Part: I can’t put the Circ-Aid on by myself. If you knew me, you’d know this is nothing short of torture. I have a very, very hard time asking for help: fiercely independent, and proud of it. This means that I have to have the Beloved Spouse put it on for me each morning. Since the Beloved Spouse’s morning often doesn’t begin till noon (he’s not an early riser by choice, and I get up with the birds and the cats), I am often without my graded compression device till mid-day. Gotta do something about this.

Another Good Part: What I plan to do about it is: work with David Klein, and my old friend the Chiropractic Adjustment Machine (CAM), to restore more flexibility to my lower spine and my shoulders. With that, I should be able, in time, to reach my ankle from a sitting position and deal with all those Velcro straps by myself. I can already do the top ones, and the middle ones — I think I could fasten them and make a kind of tube, and just stick my foot through it. But those ankle straps are the deal-breakers.

Another part of this Good Part is that, according to the graph of my last re-exam a couple of weeks ago, I’ve gone way up again since my plummeting low in June. Between January and June, I lost so many of the areas I had recovered that I was about level with where I’d been a year ago. Now I’m on the way up again. It seems to be easier to get the bones back where they should be, once they’ve had a chance to be there before.

David is happy to have a clear goal towards which we can work. And I know it will be successful.

So things are good here… my body is happy to be recovering its balance … I don’t feel as if I’m going to topple every time I take a few steps. It really is amazing, the kind of healing this elderly body is able to achieve — with the help of Mr. Clean, La Jolla’s BEST chiropractor, and several wonderful physical therapists, especially Emily Cutting.

Thanks for reading — Betsy

Monday, August 3rd — Sam the Skin has done his job well and thoroughly, I am happy to report, although it didn’t turn out exactly as I expected. But then, what ever does?

There has continued to be a small (and getting always smaller) area of hypergranulated tissue that has stubbornly refused to lie flat and low. A couple more silver nitrate burns have brought it down pretty well. At last viewing, on Thursday, July 30th, it was only the size of my smallest fingernail! Even with this bump in the middle, the Apligraf has been able to bring the edges of the wound ever closer to each other. Now, instead of trying a third skin (Son of Sam??), they’re inclined just to wait and see if it’ll completely close by itself.

It seems pretty likely that  will happen; and I will find out tomorrow if it’s happening. It absolutely amazes me how the Apligraf has melted into my own skin around the edges of the wound… and it just keeps going! Once skin has grown over the top of the last little island, it will be very fragile for a while, and I’ll still have to be bandaged up.

Hopefully, it won’t be too long till I can go back to using the Velcro Circ-Aid. The advantage of that is that I can take it off at night and just cover the leg with a soft jersey sock. Air can circulate, and that ought to help strengthen the skin. The disadvantage is that I’ll need to have the Beloved Spouse help me put it on each morning: I can’t reach far enough down to the ankle to deal with the lowest straps, because of my tantalum-and-titanium hip joints. But I think we can manage it.

Anyhow, I have a feeling of anticipation and excitement: I’m ALMOST THERE! It will have been half a year, at least, from the time I fell and got the gashed shin in February (wound the size of a cell phone, remember) to the time the last little open bit is closed over. What a journey!

Happily, I am back to seeing the Seaside Chiropractic folks twice a week now. It’s not quite as good as three times a week; but I am regaining the progress I lost during the time my body has been putting all its energy toward healing the infection, and then the wound. It’s a lot to ask of an elderly body. I am so grateful that Dr. David Klein had gotten my spine and other assorted joints into as good shape as they were when all this began!

Well, we shall see tomorrow if it’s completely closed, or still Almost.

Thanks for reading — Betsy

Monday, July 13th — Two weeks ago today, the second Apligraf skin graft was applied to my wound, after the first one failed because of hypergranulation. I want to do everything I can to make certain that this second one remains with me permanently. So I’ve named it Sam — Sam the Skin — and I talk to Sam several times a day, telling him what a great neighborhood it is, and how happy he’s going to be if he’ll just settle in and become a permanent resident.

Emily was away on vacation in Wisconsin all last week, and so Leesa took her place. Leesa’s choice of dressing for Sam was the usual foam, topped by a wrapping of cotton that looks for all the world like the stuff they used to use for quilt batting before the polyester fluff-stuff came on the market. After the cotton-batting wrap, I got a set of three pinkish wraps that looked like Ace bandages, but that are not stretchy like Ace bandages. There’s a special way to wrap these: first one clockwise, second one counterclockwise, third one in a figure-8 pattern… at least, that’s what I think it was. The result was a leg that was fat enough that most of my jeans and pants wouldn’t go over it, and a foot that was too big to go into any but my Velcro-strapped sandals, on the largest possible width.

But the neatest part of what Leesa did to help my Apligraf Sam feel happy in his new home was to use Maltodextrin powder, sprinkled over the Steri-strips that border Sam, and also around the edges at the back. Apparently my skin “macerates” easily — i.e., and literally, gets “chewed up” and develops raw spots and blisters — and the Maltodextrin absorbs any extra drainage and keeps it dry.

But wait — you may say: isn’t Maltodextrin a sweetener? Yes, it is: I looked at the list of ingredients on an extremely synthetic and unhealthy (but devilishly tasty, unfortunately) lemon meringue pie my unwise Beloved Spouse had brought home, and there was Maltodextrin, the third or fourth ingredient. What a versatile compound! There’s no way I would eat that pie; it didn’t even need to be refrigerated! And what self-respecting pie containing eggs wouldn’t beg for refrigeration? Only one that’s 85% additives, that’s what! But as a desiccating sprinkle to sop up the gooey drainage on my leg, it’s perfect.

Emily was back today. She had arranged with Angela, the representative from Organogenesis, to come  for another look at Sam the Skin, to see how he’s coming along in his new digs. And all three of us were thrilled… delighted… and amazed to see how good that wound looks! Sam has melted right into the rest of me; it certainly looks as if it’s going to be a permanent relationship. Emily took a photo and measured the wound (only 2 x 2.5 centimeters now, where it used to be 6 x 6.5 several weeks back), and we all gave each other a high-five. Angela said the Apligraf looks astonishingly good for only two weeks, and I think that is extra-fantastic, given my age.

So this was a GOOD day, and one that I found extremely encouraging. I am so grateful to Organogenesis for making this amazing Apligraf available, and to the Wound Care team at Scripps Mercy Hospital for thinking of it as a solution for me (thanks, Ryan — I think it was your idea first!)

I guess I won’t be seeing Angela again unless something goes wrong with Sam and we have to give it a third try. But everything is looking good right now, and I certainly hope it continues the same way. I am really ready for this business to be over, or at least to begin to be over. Organogenesis is pretty amazing, to have sent a rep to check this process at several points.  How lucky I am, to be able to benefit from this extraordinary medical technology!

Thanks for reading — Betsy

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