Getting Healthy in San Diego one bone at a time!

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

Saturday, March 7th — This past week (March 5th, to be precise) was the first anniversary of my first adjustment at Seaside Chiropractic. If you’ve been reading this blog for awhile, you may recall that on March 5th, 2008, I decided to “give it a year” and see what Dr. David Klein could do for my “antique frame,” as my mother used to say. Here’s a point-by-point comparison of where I was then and where I am now, in terms of my pain, flexibility, and general range of motion.

Personally, I think those are amazing improvements! I am more than satisfied with the progress I am making. I’ve signed on for another year, happily. I will continue three times a week till three consecutive re-exams show no further improvement, or until 90% of the expected possible improvement has occurred; then I’ll switch to once-a-week maintenance adjustment. I think that’s not in the very near future, however.

I hope to keep on keepin’ on with Dr. Klein FOREVER, if I get the chance. Or at least till my now-71-year-old body feels as flexible and youthful as my mind does… we’ll see when that will be. I have perfect confidence that it will happen.

Thank you so much, David, and all the rest of the Seaside Chiropractic staff, for everything you’ve done for me, and for the joy you’ve added to my life.

Thanks for reading — Betsy

Sunday, February 22nd — Just to add insult to injury, the smashed-up mess on my shin from last week’s fall in the shower has become infected. I sort of suspected it might be happening yesterday, when it seemed redder and more swollen, but I hoped it’d be better by today. No such luck.

On the whole, I guess it’s better than waiting another week and having to have the leg taken off at the knee because of gangrene. However, I am really ticked off at the Powers That Be for dumping this on me, just as I  need to be spending an extra lot of time at the computer. Just got my second book-editing job, and I’m excited about it. I do not wish to be told to lie low and keep sitting and walking to a minimum for a couple of days.

Can’t think of a way to turn this one into a joke. I’ll just have to wait it out, I guess.

Thanks for reading — Betsy

Monday, February 16th — What a Valentine’s Day we did have, last Saturday!

My eyes popped open as usual at 6:00 a.m. precisely. Fed the cats, made my oatmeal, and got to work on the computer on a website sales letter I wanted to finish. Somewhere in the next couple of hours, the Beloved Spouse arose, got his paper and orange juice, and went back to bed… the typical Saturday.

I finished the sales letter and sent it off around 11:00, and decided to take my shower and get dressed. That’s when the fun began. My shower takes a minute or so to warm up from icy cold to nice and hot, so I ran it for a bit before stepping in. Then: I stepped into the tiled stall shower with my left foot — which promptly slipped out from under me. I grabbed at the glass door and the wall to keep from falling. My right leg bent at the knee (fortunately, in the right direction, not backwards!) and I went down on my shin, right on the (tiled) lip of the shower.

So there I was, one leg stretched out ahead of me and the other bent double at the knee — a position that knee has not achieved since way before its replacement in September 1998. I’m not sure why I remained pretty clear-headed, but I did. I realized that the only way I could straighten out that leg was to get my behind out of the stall and onto the bath mat, and then scoot myself backwards till there was room to straighten the knee. (Remember, I’m six feet tall, and most of it is leg.)

The scoot maneuver was successful. Since my bathroom is only about eight feet long and a yard wide, the stall shower fills the left-hand end, the toilet takes center position in the right-hand end, and a counter runs between, with drawers and cupboards underneath and the sink in the middle. I have a screw-on raised toilet seat (for the handicapped, this is the Number One necessity in life, let me tell you), with a large plastic screw whose end sticks out from the front of the toilet. That’s where I ended up, with my right shoulder jammed against that screw. You should see the bruise.

Next on the To-Do List: yell for about five minutes to Robert, to wake him up so he could come and turn off the water. The man sleeps like a log. You’d never think he had insomnia. Next was the necessity of retrieving my bathrobe from under two sleeping cats at the end of my bed; I’ve been putting it there to keep my feet warm at night, and Amy and Chloe have pretty much claimed it. I managed to swathe myself in that, since there was no way I was going to call 911 for paramedics and have them find me sitting stark naked on the bathroom floor. I THINK NOT!

While we awaited the arrival of the ambulance — I had made the 911 lady promise that there would be no bells or sirens — Robert brought me an ice pack for my shin. I could see that it was bleeding, and there was a golf-ball-sized bump on it which I figured was a hematoma — but I couldn’t get a really good look at it from the position I was in. Much like the fall I had in the kitchen several months ago, while making Indian chai, there was no way I could turn over and get my knees under me to begin to stand up.

Plenty of time to think, there on the floor; plenty of time to figure out why I had slipped. The only thing I could think of was that I had put a wonderful concoction called Warm Cream on my feet the previous night. I order it from the Vermont Country Store’s catalog, and it magically warms up cold feet and hands in just a few minutes. I would have expected it to be totally absorbed overnight, though, and here it was nearly noon the next day. I’d been wearing my slip-on sneakers for four hours, too, and the bathroom floor hadn’t seemed slippery. It must have been because the tiled floor of the shower was wet, and there was a creamy residue on my feet. Can’t think of anything else.

The Beloved Spouse went out to direct the ambulance down our hilly little driveway and welcome them in the door. I took a few moments to shed a couple of tears of frustration and discomfort, but only a few! Then the paramedics were there. Same procedure as last time: “The Hug,” they call it — one grabbed me in a front hug and the other in a back hug, and whoops-a-daisy, I was on my feet in an instant.

They made me take some steps, to make sure I could walk and nothing was broken. Then I sat on the bed while one of them wiped the blood off my shin and applied some gauze pads and an elastic bandage. My Valentine’s Day was MADE when they asked me my age for the paperwork. When I told them I was 71, one guy said, “Jeez, I’ll have to go get the Over 65 Kit. I didn’t even bring it in because I didn’t think you looked over 65!” Almost made it worth taking the fall. Almost.

Part of the Over 65 Kit is the strong recommendation that the elderly patient be taken to the emergency room to be checked over. I had to sign my refusal in the “Against Medical Advice” section of the paperwork.  Another part of the kit is the establishment of whether or not there was any domestic violence involved. (A lot of elder abuse does take place, and a lot of it is between spouses supposedly enjoying their Golden Years together.) Before they even asked me, I announced that there was no way my Beloved Spouse had hurled me to the floor in a mad fury; the poor guy was sound asleep when I fell, and had to be roused slowly to come and turn off the hot water! I also told them I was neither confused nor demented, but I guess they had already figured that out, I was so bossy about what I needed them to do for me!

Have to say, I did spend most of the day in bed. The knee was somewhat swollen and quite sore, since it wasn’t used to that kind of a bend. That huge screw on the toilet seat had left a big bruise on my right shoulder; and the left shoulder was wrenched when I grabbed for the doorframe.  Sunday, pretty much the same — a little computer work, but mostly lying down.

Today, things are much better. Robert went out and got some long rubber tub mats to put on the floors of our two showers, and I felt much safer this morning when I showered. Swelling’s down, no more bleeding from the shin (although I fear I’m going to have to soak the blood out of my sheets, and I don’t even want to think about how I’m going to deal with the Tempur-Pedic mattress…), and I can walk almost as strongly as I could on Friday, before all this happened.

More than you want to hear about my Senior Moment? Here’s the final twist: Dr. Klein is out of town this week at a conference. I won’t be able to be adjusted till next Monday. By then, most likely all that will be left of this messy-looking contusion is a big dark bruise. But my shoulders are looking forward to his return, I can tell you that.

Now, David, don’t you think you could arrange for some kind of clone who could hold the fort while you are out of town? Work on that, will you please?

And as for me, I’m going to take it really easy with that Warm Cream from now on…

Thanks for reading — Betsy