Lost in the Woods

I haven't blogged in a couple of days simply because I haven't had either the time nor the energy. I thought and hoped that I was finally getting better, that I was finally out of the woods, but after two doctor's visits yesterday, I'm beginning to think that I'm lost in the woods without a map or compass.

Since I last left the hospital last Saturday, I've been feeling better, better than I was when I left the hospital the first time. Saturday night, Sunday, and even into Monday, I was actually feeling great. I believe it was the fact that the swelling was down in my knee combined with the euphoria from being out of the hospital for what I suspected was the last time. Whether I came out too hard at school on Monday or not is debatable, but Tuesday and Wednesday at school were days that were tough to get through. I was very tired, somewhat weak, and my pain level had slowly increased as my knee began swelling again. Although I was still proficient and enthusiastic while delivering my math lessons, I lacked my usual spark. With my leg raised all day long, it wasn't because I was doing something I wasn't supposed to. It was something else.

As my knee continued to swell again, I didn't know what to think of it. I have lost all sense of what is "normal" in a case like this now. Although the swelling was much less than last time and even less painful, it still seemed more than it should. After all, I am faithfully taking two of the strongest antibiotics on the market and I'm taking care of my leg the best way I know how. The pain was severe enough again to keep me awake at night. Tuesday morning, I woke at 1:30am. Wednesday morning, I woke at 2:30am. This morning, I woke at 2:30am again. Each time, I cannot get my knee to stop aching and throbbing enough to go to sleep, so instead I get up and read, watch TV, or grade papers to preoccupy my mind from the pain. I KNOW this type of pain at this point in my recovery is NOT normal.

Yesterday I had two doctor's visits. The first was in the morning with my orthopedic surgeon's physician's assistant, an incredibly nice guy whose bin in on the ordeal from day one. He said the swelling was likely from the surgery and not the infection, assuring me again of how aggressive they were when cleaning it out during the last surgery, spending over an hour getting into every nook and cranny, between every piece of muscle fiber, between cartilage and bones, and removing any tissue that looked even remotely like bad stuff. That made me feel slightly better, knowing that the infection was not the likely cause. He offered to aspirate the knee again, to remove the fluid to release the pressure. My wife and I both hesitated and said, "No." It's not that I feared the four-inch heavy-gauged needle, but rather, I feared what the color of the aspiration would be.

If it turned out to be yellow and thick again, that meant the infection was back. I'd have to have another surgery immediately, but my surgeon is Elk hunting in Colorado, and the PA can't go in on his own. Yellow would also mean that the two medicines I'm on are not working, and I don't know if there is anything else on the market that would work on "gram positive" bacteria. Essentially, yellow would be. . . . . you get the idea. While I sat on the exam table, I was wincing, grimacing, rubbing my knee restlessly, and moaning bit. Because of this, the PA offered once more to aspirate the knee, saying the pain relief would be instantaneous. I said, "let's do it." My wife wanted to leave the room, unable to bear the sight of the color, but instead I urged her (demanded) she stay, and she held my hand as the PA pulled out 45ccs (45ml) of RED fluid. Talk about double relief: the reduced swelling took the edge off the pain, and the color red meant the infection is gone (or leaving) and that the medicine is working. It was like I had found a trail in the woods that lead out, and I was now free to slowly walk my way out.

The rest of the day, back at school, the only pain I felt in my knee was the lingering effects of the long needle fishing around in my knee, a discomfort that was substantially less painful than the alternative swelling pain. I was really looking forward to sleeping later that night, as I'd finally be able to get comfortable and make it through the night. I even rested a bit during my conference period on a friend's sleeping mat. I nearly fell asleep right there on the dirty floor of my classroom, and would have done so if it weren't for the periodic disturbing sound of the network printer going off in my classroom. But there was still one appointment left, an after-school visit with my infectious disease doctor, Dr. W, a wonderfully pleasant, smart, down-to-earth woman who has been tracking all the numbers from my blood work. I couldn't wait to share with her my story of hope and success from earlier that day at the surgeon's office.

How quickly my optimism vanished. Being a math teacher, I tell my students all the time how graphs can be misleading. It is only by looking at the calculations, the actual numbers, do we know the exact story of what's going on. The numbers do not lie. Dr. W is the numbers doctor. She started with good news. The numbers for my Vancomycin treatment were perfect, which means the dosage level is good, and my body is responding appropriately to treatment. However, there were several numbers that troubled her. Staring at several sheets of numbers filled with lab results and blood work indicators, she said two indicators were above 100 and should have been 1/2 to 3/4 of what they were. For someone of my age on the treatment I'm on, those numbers should have plummeted by now, but were instead, alarmingly high. The single indicator that worried her the most was my blood platelet count. From the day after my last surgery to 6 days after that, my platelet count rose from 553 to over 800.

What does that mean? It means I was walking around dangerously at risk for a blood clot. The count should have either declined or stayed the same, but because it actually rose dramatically, she said that something is still unresolved in my knee. Tell me about it! Unresolved seemed like an understatement. She called my PA from earlier in the day on his cell phone right there in the office in front of me. I heard their entire 5 minute conversation about what to do about my knee. The PA was still of the opinion that I was great and getting better (as I had now believed), but Dr. W was recommending another surgery to wash out the knee. That's right, another surgery. My heart sank when I heard this, but it fell even lower when I heard the PA say that if they went back in, they would likely have to cut open the entire knee to get it cleaned out better, rather than arthroscopically again.Who cares about the big, long, ugly scar it would leave, it would mean a longer hospital stay, a longer recovery, and more time missing school, something I want to try to avoid at all costs.

When the phone conversation ended, Dr. W said cheerfully with the most happy face, "Some of the surgeons call me the 'Black Cloud.'" We shared a good laugh at that one, but I couldn't fault her for suggesting another surgery. Her comments and the lab numbers only confirmed what my intuition has been all along this week: something STILL doesn't seem right.

As it sits right now, I'm taking 325mg of Aspirin a day to help lower the platelet count, and we're waiting for my surgeon to return from his hunting trip. I'm supposed to schedule an appointment with him for sometime tomorrow (Friday) to discuss the entire situation with him. This will not be an easy task, as we don't know when he's getting back and the fact that his office and my schedules are currently "booked solid." The fact that I couldn't sleep again last night, even after taking the 45ccs out earlier in the day, means that the fluid has already refilled Dr. W's recommendation is probably what needs to be done. But I still have until tomorrow. That gives me precious little time to will my platelet count and the other two indicators down, to will my knee to reduce its swelling, to hope for a miraculous turn around, and to find that hidden trail that leads me out of these woods.