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Apr 2, 2018 Latest post:
Jun 15, 2018
Welcome to our CaringBridge website. We are using it to keep family and friends updated in one place. We appreciate your support and words of hope and encouragement. Thank you for visiting. This is Gary's story of his journey with osteomyelitis.
On Sunday February 4 Gary woke with pain near a tooth that had undergone a root canal some time ago. He took a couple of antibiotics the dentist had given him before and the pain and tenderness went away. On the following Tuesday night, February 6, he awoke with a slight sore throat, got up and took Zicam, thinking he was getting a cold. On Wednesday, February 7, he awoke with severe pain in both collar bones, but worse on the left side. I told him he had probably slept wrong and had chest wall pain like I had before. But it kept getting worse, and he said it felt like his collar bones were broken. The pain shifted more to the right, and he developed swelling, redness and pain at the collarbone joint and up the collarbone toward his right shoulder.
This continued to worsen, and he developed a slight fever. Since we had been exposed to the flu, he took two doses of leftover Tamiflu on Friday, February 9. We tried to get an appointment with his doctor, but they were closed. So, we went to Urgent Team in Tullahoma that evening, and they tested for flu and strep; both of which were negative. The Nurse Practitioner said the Tamiflu may have given a false negative result. They X-rayed his collar bones and chest, and they looked normal. Then they gave him a steroid shot and a prescription for more Tamiflu.
On Saturday, February 10, he felt better, so he did not take the Tamiflu. On Sunday, February 11, he awoke feeling bad again. On Monday, he had severe spasms in his neck muscles and his muscles were knotted and hard. We went to his doctor and she examined the swelling on his collarbone and neck and the tight muscles. She gave him a prescription for muscle relaxers and sent him home.
On Tuesday the 13th Gary’s pain and swelling were worse and spasms were really bad. I asked our neighbor who was also a chiropractor,, to come over an try to release the spasms. While examining Gary, he told us it could be a possible infection since the area around the neck and collar bones have a lot of lymph nodes. He said if it got worse we needed to go to ER.
That night, the pain became unbearable, and we went to Harton ER. He was hurting to badly to try to ride to Murfreesboro. The on-call Hospitalist gave him Fentanyl and Dilaudid shots, but they did not ease the pain. They finally did a CT scan and told us he had either a tumor or infection in the collarbone area and that we needed to get to an orthopedic surgeon as soon as possible. We were in the ER from 10:30 pm on February 13 to 4:30 am February 14.
That morning after 2 hrs of sleep, I began trying to get an appointment with our orthopedic surgeon. That afternoon we went to our Orthopedic specialist in Murfreesboro. He did X-rays, looked at the scans from Harton and said it was more complicated than he was comfortable handling due to all of the major nerves and blood vessels in the area. He also said it was more sophisticated than the hospital at Murfreesboro could handle. He said we needed to be at Vanderbilt where they had the doctors and research facilities to deal with the issue. He called and arranged for Vanderbilt to see him in the ER.
We arrived at Vanderbilt around 4 pm Valentine's day. The flu epidemic was rampant and people were wearing masks all over the hospital. It was like something out of a science fiction movie. We finally saw a doctor around 10:30 pm. They were going to admit him, but had no beds. So, we stayed in the ER Department for three days. He had a multiple teams of doctors from Infectious Disease, Thoracic Surgery, Spine, Ear Nose and Throat, Speech doctors consulting on his case. He had multiple blood tests and cultures, multiple MRIs and CT scans with and without contrast.
The CT Scans MRIS showed a pocket of infection behind the breastbone, but they didn't know where it was coming from. He had no open wounds it injuries that could have caused it. Again, because if the location of the infection and the blood vessels around it, they did not feel safe in doing a needle biopsy for cultures. He had surgery on February 17 to drain the abscess and obtain cultures. After about 3 days, The cultures showed strep veridens bacteria that live in the mouth and throat.
The medical team first feared the bacteria had seated in the 6-inch titanium plate in Gary’s neck or had come from the ulcers in his esophagus. But the endoscopy and MRIs showed that wasn't the case. So the only thing they could decide was the bacteria most likely came from under the tooth with the root canal.
We were in Vanderbilt on IV antibiotics (Vancomycin) the first time for 8 days. They had to change it to Unasyn because the vancomycin was too hard on his kidneys. He went home on February 22 and was on IV Unasyn at home for 4 weeks. We changed the bag every 6 hrs round the clock til March 18.
We went for a follow-up appointment with the Infectious Disease specialist and had CT scan on March 13. On March 15, the Thoracic surgeon explained that scan showed the infection had eroded the head of the collarbone joint and the bone itself.
On Thursday, March 22 at 11 a.m, they did a second surgery and removed the joint/head of his collarbone and an inch and half of the collarbone itself. They took Gary back to surgery about 10:45 for the prep. His surgery was to start about 11:15-11:39. They told us it would take 3-4 hrs, and he would have a 3-4-inch incision, 2-3 inches deep and go home with a wound vac. He dreaded this so much.
I don't understand why he has suffered so much in his whole life. He has a big heart and cares so much for other people. But God knows and He always works things for the good for this that live Him and who are called according to His purpose.
So this is how the Lord worked that day..
Surgery went well and was only an hour long. The incision was not as large only about 2 inches long and 2-3 inches deep. They took the joint and about an inch and half of the collarbone. He was awake and doing well. The infection had been eating away at the bone despite all the antibiotics. It was mushy and dead and crumbled when they removed it. He was in Vanderbilt Hospital til March 24. He went home with the wound vac for about a week and a half and on the IV antibiotics for about 2 weeks with Home Health 3 days a week to change the wound vac, They told us it if that didn't work, they may have to take the entire collarbone and possibly the first rib on the right side. He continued with the Ceftriaxone IV antibiotics at home and they added Flagel antibiotic.
On March 26 the site started swelling and holding fluid, and he had intermittent fevers. The wound looked good when the Home Health nurse changed the packing on Tues and Wed, March 27 & 28, I suspected the site had sealed too soon and had trapped fluid and bacteria behind it the incision. The swelling increased and the nurse could barely get the packing in on Wednesday. I called Dr. Nelson and Dry Grogan's office on the 27th and Grogan saw him Thursday March 29. When Dr. Grogan’s assistant Ferron examined him, she could not get a cotton swab in very far. Dr Grogan examined him and said it had closed off. He told Farron to get some numbing medicine to numb the site. She just looked at him. Then Dr. Grogran started talking and joking while he took his finger and punctured the site and opened the wound with his finger. He never numbed this 2-inch incision. Gary just closed his eyes and never made a sound although it was so painful.
Afterwards, Farron began packing the wound using a sterile cotton swab. The wound had to be repacked every day. Grogan took off the wound vac during the office visit on Thurs March 28. On Friday, March 29 the wound looked fine, pink-red healthy site. On Sat. March 31 when home health nurse unpacked the wound, it was full of greenish/yellow pus and sloughing skin. I immediately began calling Dr. Grogan and Dr. Nelson’s afterhours numbers and arranged for them to meet us in the Vanderbilt ER. Kristen Wernesky from Dr. Grogan’s office said she would meet us there, and Dr. Cohen said if she was already gone when we got to Vanderbilt, she would see us the next morning.
We went back to Vanderbilt ER, had a CT scan, blood and wound cultures, and was admitted. Dr Cohen told us on Sunday morning, April 1, that the CT scan showed infection in the bone again. She said that the surgery team did not send bone from the second surgery to pathology to make sure it was clear of infection and that the wound would have to be debrided and more bone taken til they got to healthy bone and she would make sure it was sent to pathology.
Gary has surgery today, April 2, at 730 am to debride the wound and take more bone.
We are still waiting for testing for CDiff infection in his Colon, They told us that the only bacteria not covered by all the antibiotics that Gary has been on was MRSA. We are waiting on the cultures to confirm if this is the case.