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