Doing okay ....

Thanks for all the e-mails, comments, calls, etc. this week .... they have all been great! I am hanging in there and am doing okay. Yesterday and today were pretty long days at work and there ended up being more pain than I anticipated. The pain does improve a little each day, which is a positive. I will be ready for the weekend & time to rest more.

The incision is longer than we/I had planned, but I think there was more to "clean out" than we originally thought. I peeked at the incision tonight and it is about 6-7," but the good news is that it looks awesome! The healing process has started, all is closed, no gaps in the skin, no holes or anything that resembled the possibility of opening. It is a very thin incision line and the stitching runs under the skin in one single, long stitch (looks like fishing line). The skin was nice and pink and looked better than before.

I've been able to sleep very well the past two nights, which is a huge blessing. Sleep does a lot to aid in healing. Very thankful for no cast or crutches this time. The bulky bandage is nothing, compared to what I've had in the past. We should get the path report back sometime around the first week in November - pray for a definate diagnosis & something that is treatable. Need to get back to elevating the foot ..... don't want blue toes!

je

Home with a closed and happy foot ....

Yippee .... I am done with chilly OR room #19!

I’m home and all went well with the closure surgery this morning. I slept well last night and we arrived at 6am at the downtown surgery center. I couldn’t believe how many people were already there and “in process” for 6am. I met w/Dr. B and his assistant, before I met with the anesthetic team. They showed me the MRI pics of the tendon area that was 5x bigger than normal. Five times larger was being conservative …. it could have easily passed for 10-15x larger. His plan remained the same – open it, biopsy in several areas, clean-out and closure. Dr. B’s guess is that the path report will show something in the micro-bacteria category, which he said can be treated with medication although it takes several months of medication. I am assuming oral and not IV, but we’ll figure that out later.

When I met with the anesthetic doctor, that was rather humorous. My heart rate was really high & he asked if I was nervous (no …. just running all around the house with last stuff, before I left the morning). His first question to me was whether I had ever had surgery before. Dr. B was still in the room and we both laughed before either of us answered the question. Obviously he had not read the “previous op history” section in the patient chart notes. I kindly said “yes,” that I have had multiple surgeries. Then I went on to tell him that I bet I could tell him what he was going to do next, because I’d done this so many times. I don’t think he believed me, so he told me to make my best guess. I quickly guessed that he was going to ask me to open up my mouth, so he could look inside (standard procedure in case a patient needs a breathing tube). To his amazement, I was right! He asked if I wanted to start my own IV, but I declined! :)

He didn't even make me put on the crazy surgical hat until the last final second .... and then when I woke up from the surgery the first thing that the nurse told me was that my hair still looked good. Gotta have those hospital priorities!

All went well & as planned with the surgery this morning. The synovial membrane inside the tendon was ”messed up,” as Dr. B put it. Too much of the synovial fluid, mayo substance stuff causes the healing cells to not do their job, which we are guessing is what happened. He cleaned it all out, sent samples to the pathology lab, re-stitched, and then closed w/new sutures. No cast, just a bulky dressing that will probably only fit into a glorious, blue surgical shoe for the next two weeks.

I’m somewhat tired, but overall am doing well. Thankfully no post-op nausea or vomiting. The ankle block has not worn off yet, so as of now there is no pain …. it will happen with time. I can put weight on my foot – just no more than needed. My first post-op appt. is in two weeks and then I’ll be able to see how we are doing with healing. It is SO, SO great to be home and not stuck in a hotel somewhere. Still planning on returning to work tomorrow morning. I warned them that I may be a little late .... mornings are slow going & getting ready takes longer than usual.

Thankful for a successful surgery and praying for a good path report in 6 weeks ...
je

Last Step Tomorrow .... hopefully!

Like my scooter décor? Just a little lighthearted fun, since I work with kids. Hopefully it will be the last time that it needs to be decorated. They will all be asking me to ride it next week. I do a significant amount of walking at work (easily 4-6 miles a day), so I'll use the scooter at work to help give the foot more healing time. Thankfully we have huge open areas at JA & an elevator, so it makes it easy.

It has been a busy weekend of getting final things in order for tomorrow and the upcoming week. I’m ready for our early morning on Monday and couldn’t be more at ease. I will see Dr. B before surgery and have a few additional questions for him, but nothing big. I think he only has an hour planned for the surgery, so it won’t be long.

Prayer requests for tomorrow are listed below …. Last night I was fearful about the possibility of more issues starting because of another operation, but then I realized that I can’t worry about that. If there is some bacteria/bug that is deep, we have to know it & get it treated. God is in control. We’re still praying for the surgery tomorrow to be the last one and for a good pathology report in six weeks.

I was Martha Stewart in the kitchen this weekend. I made Praline-Apple bread, pumpkin cookies, lasagna, chicken divan, potato soup, egg salad and tuna salad ….. all to take to mom/dads house to try & make food prep easier for her this week. This is WAY more than I make for myself in one week, but it will help make things a bit easier.

I’m having an early dinner at mom & dad’s house tonight (meatloaf) and then home to bed early. I went to church this morning and it was good to sing the song “It is Well With My Soul” – love that message.

7:30am – surgery time … will update the blog tomorrow afternoon. … so long open foot!

“My God will use his wonderful riches in Christ Jesus to give you everything you need.” Philippians 4:19

Praising Him tonight for His faithfulness,
Jenny

Pre-surgery prayer requests .....

There has not been a lot new happening this week, other than getting things in place for Monday. I am incredibly glad that it is only two days away! I found out today that Dr. B has been on vacation all this week, so he should be nice and rested (let’s hope).

I finished pretty much everything at work that I had hoped to get done. I tried to do anything involving more walking this week & will plan to sit more next week. Tonight I stopped at Pei Wei on the way home and got
take out for dinner … it was great!

Prayer Requests for pre-surgery ….
- Skill, wisdom, & for no big surprises for Dr. B in the midst of surgery.
- Good anesthetic person (that anti-nausea meds will work)
- Minimal pain & quick recovery in the post-op area
- Skin healing – that it will happen & will heal well
- No new problems will begin, because of another operation
- Path report; patience, clear diagnosis & treatment plan
- Closure …. incision, foot journey, skin & this is the final “step”

I’m still at peace and am confident that all will go smoothly on Monday. Just being able to come home will be a treat!

Abiding in Him,
Jenny

Pre-Op Testing Done .....

The pre-op testing is now done and we are “good to go” for Monday, Sept. 28th at 7:30am. We have to be at the Center for Advanced Medicine (downtown) at 5:30am on Monday and it is a strong 40 minutes from our house. We’ll be up with the birds on Monday. I was reminded again today of why I’d never choose to have surgery at a large hospital … if you aren’t sick when you walk in, you probably will be when you leave. I am so glad that we will be in there early and hopefully outta there by late morning. Everything gets back up with time if you are a later case, so thankfully that won’t be a problem.

The nurse that helped with the pre-op testing said that I knew more about anesthesia and surgery than any of the hundred patients she had seen today … no surprise there. After this long, something is wrong if I don’t know about it! She laughed and laughed at my ”handout” that listed all the surgeries and my anesthetic chart of what works for me. I certainly wasn’t going to write it all out by hand or I’d have been there another hour. The nurse also said that Dr. B is a spectacular surgeon – good to hear once again.

Decided to pass on getting a pedicure this week, but I’ll do it myself. I don’t need some sudden infection from the nail tools. I had to purchase two new batteries for the scooter today – somewhat of a bummer because I hope to sell it at some point & didn’t really want to invest more in it, but such is life. I will be glad that I have it next week.

My staff can’t believe that I’m going to come back to work the day after the surgery, but Dr. B said that I could. If I don’t feel well, I’ll make a phone call and can bump it back a day. I have a million things to do before kiddos arrive the following week.

Thankful that all is in place & am so looking forward to the next step.

Off for a snack of apple slices & caramel dip ….
je

Seven days and counting .....

This weekend has been much better knowing that we have a “closure plan” in place. The past two weekends were not the greatest. Tomorrow (Mon.) I talk w/Dr. B’s op scheduler to confirm that 7:30am is the surgery time for 9/28. It will be an early morning, but there are big advantages to being his first surgical case of the day. It will seem odd getting to come home after the surgery, as usually we are back to a hotel, hospital room, or a friend’s house.

On either Tues. or Wed. of this week I have to go to Barnes downtown to do pre-op tests & blood work. The Barnes anesthesia dept. requires more than any place I’ve been, which is why there had to be one week between when I scheduled and the surgery. I have a handout on what anesthesia works & what doesn't for me .... bet they haven't seen that before! They said to count on at least 2 hrs., so that really means more like 4 hrs. – will bring my lap top & munchies.

The incision area that needs to be closed is about the size of the end of two Q-tips pushed into the skin & a hole has formed on each one. It started out looking different, but because it has been like eight weeks it formed a hole shape. It won’t look that way after he closes it. There is an area on the inside of my foot that he looked at initially too, but he didn’t say anything about that on the phone – maybe I can get him to just re-stitch it.

I am on my last roll of bandage tape, so I am hoping to make it through this week w/it and then there won’t be a need for it anymore! Planning on staying w/mom & dad for the first week and then will see how I am feeling and if driving can happen then or if I need to wait longer.

This surgery will be one of the more minor ones that we’ve done & by now I know the “surgery day routine” quite well, so I’m really calm & at peace about it all. It won't be anything that I haven't already experienced.

Pray for the next seven days to go quickly ….. I’m ready to be done, done, and done! Thanks for continuing to pray for a successful surgery, path report will be definitive, and that the skin closes well in the upcoming six weeks.

je

Countdown to Closure .... 11 days

LONG POST: Read when you have time ….. I will attempt to explain this as simplistically as possible.

After consulting with five plastic surgeons in the past six weeks, we have FINALLY made some progress. The current situation with the open incision area has definitely been one of the most challenging in seeking knowledgeable medical options, remaining patient and working hard at making wise decisions. On Monday of this week, I had mentally resorted to just “living with it,” but that has all since changed.

Just a refresher on the key players … Dr. B is the plastic surgeon w/Wash U that attends our church. Dr. K is my STL orthopod. This blog post is longer & requires explanation, so hang with me here:

From 3:30-4:30pm yesterday I had a meeting at the American Water Co. that I had to speak at & don’t you know Dr. B called my cell phone during the meeting. I was dying inside as I saw it on the cell phone & I could not stop and talk. I’ve been waiting for like 3+ weeks for the call!

I ran to my car after the meeting and called back the number & had to leave a message at 4:40pm for his secretary. She called back at 4:50, much to my surprise – late in the day. So, Dr. B & I started talking and 10 minutes into the conversation we get cut off w/the connection … so I call back, but then it took 3 tries (night machine – after 5pm) to reconnect on the phone. Satan was working overtime to try to hinder the conversation!

Here is the upshot …..
-Dr. B had talked with the radiologist and got the report from Dr. K from my appt. w/him last Friday.

- Basically both doctors are right … there is no bone infection (huge praise), but there is likely some other deep “bug” (bacteria, fungus, something weird) in the tendon/soft tissue that lies just below where it is open.

- My tendon is 5x the normal size on the MRI, so something is wrong. He feels whatever is deep has caused the skin to open and has inhibited my ability to heal now & likely in the past (would explain a lot).

- I don’t have the “normal” infection signs, which makes this so hard.

- There is a lining on the inside of the tendon, called synoviam, that may be harboring the “bug” that could/should be totally cleaned out for starters. Whatever “it” is happens to be in the soft tissue/tendon and not bone, which should be easier to treat.

Pathology 101:
Synovial membrane is the soft tissue that lines the surfaces within joints with cavities. The word "synovium" comes from a Latin word meaning "with egg," because the synovial fluid in joints that have a cavity between the bearing surfaces is like egg white.

Synovium can become irritated and thickened (mine is 5x the normal size). When this happens, the synovium can become a danger to the bearing surface structure in a variety of ways. Excess synovial fluid weeping from inflamed synovium can provide a barrier to diffusion of nutrients to cartilage. The synovial cells may also use up nutrients so that the glucose level in the tissue is almost zero. These factors may lead to starvation and death of cartilage cells (ie - wound issues can happen).

- A biopsy of the area needs to be sent to the lab and cultured and then hopefully treated w/some oral medication. He said that this is really “out of the box” & is super hard to diagnosis, but a sample of what is inside is needed for starters.

Plan:
- I scheduled today to have the biopsy & closure procedure done. Dr. B will go ahead and clean out whatever is needed and close the wound. He would rather not do a skin graft, because of the area where it is at on the foot. The area should stay closed if we get the “junk” out of there & treat w/proper medication.

- It will take 6 weeks to get the pathology lab report back. If we are lucky, the wound will close and stay closed during the 6 weeks and then we’d just treat w/some medication/IV (depending on what is found).

- If the area doesn’t remain closed or gets worse, then he will need to go back in and re-open, etc. He said that usually the first procedure is not a cure, but more of a fact finding mission.

Best Case Scenario: The wound would close well in the 6 weeks after the procedure and whatever is found on the pathology report is easy to fix with medication. I.E. No 2nd surgical procedure would be necessary.

This has to be done at the Center for Advanced Medicine Surgery Center (downtown) because that is where the best pathology lab is located, so I agreed (of course we want the best). It is not at big Barnes. He said it is new facility, good staff & it would be a positive experience (counting on him being right on this).

One day procedure …. Ok to return to work the next day.
Can walk on it right away; although not lots of walking for 1st week. No cast needed - yippeeee!!!!

6 weeks is a long time to wait, so I am fairly hopeful that we might be able to get it to stay closed – often it happens in 4 weeks.

Stitching by a plastic surgeon is always much better than any other surgeon, so that is a bonus. The surgery is scheduled for Monday, September 28th at 7:30am. (biopsy, clean-out, closure). I can return to JA the next day and will plan on a light work day w/no major decisions! I will stay w/mom & dad for at least the first week & won’t drive.

I will have one week between the surgery and when I have kids beginning on a daily basis at JA … close on time, but at least it is not like 48 hrs. prior to seeing students. God is good.

I am ok w/all of this, praising God for the progress we’ve made, thankful for lots of faithful prayer warriors & am ready to take the final step in a long journey. God has moved mightily and that is the sole reason for all of this coming together. We were a million miles away from any possibility of getting a resolution to this all last week.

Dr. B was extremely professional, gracious, and gave me an elaborate explanation of all of this on the phone, so he gets the Dr. Thorough award. I was crying in happiness as I listened to him talk, but he didn’t realize it. He is the first physician in months that has really taken time to dig deep & look for an explanation behind the problem. We WILL pray hard that the area wouldn’t need to be opened a second time. (If we have to operate a 2nd time we will cross that bridge, if required.) JA continues to be exceptionally understanding with all of this.

Six weeks is a long time to wait, but hopefully the area will be healing at the same time. I asked what are the odds that he gets inside & finds nothing … he said it is very unlikely & don’t count on it happening. Dr. B was really pleased on the phone that he thinks he has found the root of a deep problem & I wholeheartedly agreed. We have a plan in place. Think of how far we have come and how close we are to being finished …. Six weeks is nothing on second thought. No question about it …. God has provided the right doctor to work on the case.

Thank you for your patience and praying.

“Let us therefore come boldly before the throne of grace, that we may obtain mercy and find grace to help in the time of need.” – Hebrews 4:11

Thankful to Him who provides ….
Jenny

Progress is happening .... keep praying!

We are making tiny steps of progress although I'm not at a place where I can share/explain the details quite yet. Please continue to pray tomorrow (Wed.) that more things fall into place and I'm able to get the necessary appointment needed (hopefully for next week). I'll write more as soon as I have additional details in place. Know that God is at work and your prayers are making a difference. There is a sense of peace amidst everything that is occurring and in the end God's plan will happen .... He will orchestrate whatever is to happen. Today was the first day in several weeks that I was more encouraged about bringing closure (in more ways than one) to all of this - will share more in the next few days.

"God is faithful; he will not let you be tempted beyond what you can bear" - I Cor. 10:13

je

Slow progress ....

There is not a lot to report from this week …. I did see my STL orthopod on Friday & he did not see any infection on the most recent MRI. He also had a radiologist at Barnes West review the films and he agreed. We couldn’t locate the exact image that was cause for concern from the plastic surgeon. No word yet from the plastic surgeon’s office. Keep praying for timing, wise decisions & encouragement.

je

New & hopeful week ahead ...

It is a new week and I’m ready to carry on! It has been good to have a longer weekend to get refreshed with energy, stamina, rest, new attitude and I’m hopeful of taking the next step ahead this week.

Toward the end of last week and increasingly over the weekend pain has reoccurred which has not been there for a long time. On Saturday night, I finally resorted to narcotic medication. It helped marginally, but it was enough that I could sleep. Not totally sure where the pain is stemming from, but clearly something is not right.

I’m hopeful that I’ll learn some news from the plastic surgeon this week & will likely make an appt. to see the STL orthopod as well. I suspect that he doesn’t realize what is (or is not) happening w/all of this. After a holiday weekend it will be tough to get anything going on Tuesday, but we’ll see.

Good quote for this week .... "If God sends us on strong paths, we are provided strong shoes." by Corrie TenBoon

Keep praying for wisdom in decision making, timing, pain relief, and a correct/clear diagnosis.

je

Waiting, waiting & more waiting . . .

The week ended with no news from either the plastic surgeon or my STL orthopod. I e-mailed my STL ortho dr. yesterday and asked him what his opinion was of a possible bone infection on the MRI, but I didn’t hear back from him.

I am having major second thoughts as to whether or not I’m working with the right plastic surgeon. He isn’t doing anything wrong w/patient care or being cautious, but communication is sorely lacking. I cannot speak to a human when I call his office and always have to leave a message …. this is annoying to say the least.

I realize that my case may be challenging, but to go 2+ weeks after an MRI and not have an accurate reading is starting to border on unacceptable. My Chicago dr. always told me that as the patient, I should always feel in control of the medical situation and if I don’t, then something is wrong …. I’m not in control of much at the moment. Unfortunately, it is not like there are other easy options out there for other physician opinions.

My biggest concern is that w/every few passing days, the open areas get deeper/larger. I know from past experience that if the area is too deep, skin grafting no longer becomes an option. This is the problem that I had before that led us to San Antonio …… this definitely cannot happen again. I have kids at work in 4 weeks & on the first day there are 140 kids, which is over our maximum by 20 kids … timing is not working in my favor.

I had 5-6 things this week that I had to say “no” to doing (Make-A-Wish assignments, holiday musical, date stuff) because I don’t know what will happen w/the next several months …. Life on “hold” is not a fun place to be & we haven’t even started the recovery weeks yet, which is usually the hardest part.

Someone at my office today joked w/me that what I'm experiencing would be what it could/would be like if we had national health care (waiting, waiting & more waiting) .... sad to say, but they are probably right.

Enough rambling ….. God is still in control & His plan is perfect. I am not required to have it all figured out, but will be happy when there is a plan! Tonight I planted fall mums at my house and took out some frustation digging. Hanging in there …. I’ll make it. Off for mint chocolate chip ice-cream ….

Happy holiday weekend to you!
je

Quiet week .....

Post #350 .....

No news to report yet .... I've not heard anything back from Dr. B's office. At about 2:00pm today I couldn't stand it anymore, so I called his office and was going to leave a message for his nurse. His nurse was with some patient & I thought I was leaving a message w/the receptionist, but she went and gave his nurse my message while I waited on the phone. The receptionist gal told me that Dr. B had not spoken w/the radiologist yet and that his nurse would remind him about it again when he returned from surgery. Dr. B is at the West Co. campus the remainder of the week, so it is likely that nothing will happen on this now until Tuesday or after of next week.

I did talk to another friend that is a doctor & she told me that bone infection typically does not spread into the blood or other places, so that is partially why no one is in a rush. Supposedly, people walk around with chronic bone infection sometimes a long time before they know they have it .... many times the symptoms are very minimal.

I had a lot of foot pain today at work - not sure what that was about. Toes are still laying flat and the thankfully the positioning still looks good.

The bummer is that we may be waiting for nothing, if there is no infection! Patience, patience .... it is hard. It is going to be a long holiday weekend .........

je