Happy Easter Dylan

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Final Medical Post (I hope)

The doctor at Lahey Clinic gave me the surgical notes, So I thought I would share that with all of you.

INDICATIONS:Patient presents with a septic right shoulder.   She has had two surgical procedures done elsewhere.  She had persistent drainage.  She presents for surgical treatment.

PROCEDURE:  The patient was placed on the operating room table.   general anesthesia was induced.   the patient was placed in a sitting position.  The right shoulder was prepped and draped incision made over the anterior aspect of the right shoulder through the old incision, down through subcutaneous tissue and fascia.   there was some purulent tissue that initially expressed.   The deltopectoral interval was then entered and necrotic tissue was removed throughout the deltopectoral interval.   the subscapularis tendon was then incised off the lesser tuberosity and some purulent tissue was also removed and sent for culture.   There was a significant longitudinal tear of the supraspinatus tendon off the greater tuberosity,   the bone was significant longitudinal tear of the supraspinatus tendon off the greater tuberosity and in probing the greater tuberosity, the bone was significantly soft.   The bone was entered.  there was noted to be some necrotic bone which was debrided using a curette and after the shoulder was copiously irrigated, and the decision was made to put a few sutures in the supraspinatus tendon rent.   This was done with Prolene suture.   after purulent synovium was debrided and bursal subscapularis tendon was left open.  The shoulder joint was left open.  the wound was  packed with betadine soaked sponges and a wound VAC was placed in the shoulder. Patient was awakened and transferred to the recovery room.

Since I didn't have a room yet, I spent the next 24 hours in the recovery room.  Was actually very nice.   I got lots of attention.  

Life is Good

No more gory pictures, just a note to let everyone know that I am doing better,  I had half of the stitches removed from the shoulder on Friday, and hope the rest will go this friday.   The infectious disease doctor is pleased with how the infection is looking but wants to keep me on the IV antibiotics for another 3 or so weeks.   I would rather have too much and make sure the infection is gone, rather than not enough and have it come roaring back stronger than before.  The xrays showed that the bone seems to be healing, so that is also good news.  Now i have only a week to wait before I can start with the occupational therapy to get the arm moving again.

MaryAnn Status 5/12

Things have gone very well today.  We've met with multiple doctors, most notably the infectious disease doctor.  Right now the feeling is that she will be able to go home on Thursday morning.  Tomorrow they will pull together the home treatment stuff.  The antibiotic regimen is not simple and definitely has the doctor scratching his head, but he  will have it together tomorrow.  The orthopedists are happy with how everything looks.  The endocrinologists are happy about her glucose levels and are confident she will be on oral medication when the infection is done with.  She is feeling good, walking well and the shoulder is not causing much pain.

I'm heading home tonight and will work tomorrow and after my church meeting Wednesday night I'll head up to the Hutchins' and then come over to the hospital on Thursday to pick her up.  Right now that's the plan, we know it could change, but would certainly like it to happen like this.

Above are pictures of the scarf that a high school friend sent and a picture of the shoulder

Hospital Update 5/9

Here is a link to pictures of the hospital room, the line in her shoulder, and the suction device that is constantly running to get the "bad stuff" out of her shoulder. All is well we are just waiting now until Monday when the line is removed.

http://gallery.me.com/kohl/#100053

Surgery 5/7

The surgery was completed at about 5:30 PM.  I met with Dr. Smiley.  He took out a minimal amount of bone.  They did some repair of the rotator cuff.  There will be a follow-up surgery on Monday and she will need to be in the hospital until at least Tuesday.  I have seen her twice this evening and she is doing well.  On the last visit we got to talk with the doctor that assisted Dr. Smiley.  He felt that it went well. They took tissue samples and are culturing them and if they find anything unexpected they will address it during the Monday surgery.  I am staying at the Hutchins' home in Belmont right next to the temple which is about 15 minutes from the hospital so I will be well rested.

MaryAnn Status 5/4

We went to the Lahey Clinic in Peabody this morning and met with Dr. Paul Smiley.  He agrees that surgery is needed and is now scheduled for Thursday (5/7) in the Burlington facility. He knows that some bone will have to be removed, but until he gets in there he does not know how aggressive they will have to be.  Right now our focus is on eliminating the source of infection and he agrees with that.  How much bone they have to remove will obviously determine what degree of reconstructive surgery will be required, but that is in the future.

We probably will be heading up early Thursday morning, but we'll know the time  for sure on Wednesday. She could be home as early as Saturday depending on how things go.   It was a very efficient morning up there.  We left home at 8:20 and were home by 2:20

MaryAnn Status 5/3

Well, it didn't work out quite the way we hoped it would, but we're moving forward.  Lahey Clinic would not accept her for a hospital to hospital transfer, so she will have to go in for an outpatient checkup and then be admitted.  She was released from Newport Hospital Friday morning with a new antibiotic treatment regimen and we have an appointment on Monday with Dr. Smiley at the Lahey Clinic.  Hopefully they will examine her and decide to admit her then.  We had a nice weekend at home and are ready for a busy week.  She received a priesthood blessing from myself and our home teacher so we are moving forward in faith.   I will update the status after we meet with the Lahey folks.

MaryAnn Status 4/29

Well we're moving ahead.  Today we continued  to push toget her moved to Lahey Clinic (Burlington, MA (north of Boston), which hopefully will take place tomorrow.  There are bureaucracies that have to be waded through in making things happen, but we see movement.  The MRI confirmed what we have suspected which is that the bone infection is getting worse.  Knowing that she will soon be seeing professionals that lead their field makes us feel better.  That being said we are grateful for the local doctors  - they worked hard and did the best they could and they are totally on board with her going to Lahey.

We did get some good news today that the C-peptide test that she recently had shows that her body is producing lots of insulin, so that once the infection is gone she should be able to be on oral medication or perhaps just on diet.

She continues to be of good cheer and is grateful for the phone calls.

I don't know exactly when we will be going up there.  I will endeavor to get an update out tomorrow.

MaryAnn Status 4/28

Today was just gathering data.  She had an MRI of the shoulder which is key to determining how the bone infection looks.  We had a discussion with the orthopedist on treatment options if the bone infection has gotten worse.  The technical term for a bone infection is Osteomyelitis and it doesn't always respond well to antibiotics.  Surgery may well be the only option and if it has to happen we will not have this done in Newport.  We are working through Susan Moran Mathieu to get her into the Lahey Clinic in the Boston area.  I know surgery doesn't sound great, but having a chronic infection is not good.  We should have a pretty good idea by the end of tomorrow as to what will be done.

MaryAnn Back in the Hospital 4/27

Two steps forward, one back.  After a bout with fever on Sunday afternoon and another one today we made a decision to bring her to the emergency room and they decided to admit her.  It is clearly a problem with the infection.  I am coming to realize that it is not an easy thing to get this right.  The last time she was in they put her on Vancomycin and that is what they have done this time.  Clearly they have to come up with an antibiotic that will work better for maintenance at home, otherwise she is going to be in the hospital every week.   Hopefully this will be a short stay and the third time will be the charm.  Prior to the fever she was doing really well.

MaryAnn Status Is Home

MaryAnn got home on Sunday and is doing well.  

MaryAnn Status 4/16

Things are going fairly well.  I need to correct what I said about what the orthopedist found.  The pus had accumulated since the first procedure.  He cleaned out the same area the first time and there was no accumulation there, so clearly there was a change for the worse this time.  The infection was definitely not in the shoulder joint.  The main work now is clearing up the infection.  They are referring to this now as a "wound infection" and are treating her with antibiotics Cefazolin and Vancomycin, which are specifically for that type of infection.  

She may have the followup shoulder surgery tomorrow to remove the packing material.  I'll report on that tomorrow.

MaryAnn Back in the Hospital

Well, here we are again doing something I hoped we wouldn't have to, but it looks like it's all good.  She had the shoulder surgery at about 5:00 this afternoon.  The procedure went well.  He found a pocket of pus that he had missed the first time that definitely was causing a good part of her shoulder problem.  She got back to her room at about 7:30 and had a good dinner. There are some good things that will come out of this.  The infection status will be evaluated and they will see if the antibiotic she is on is doing the job and also they are playing with her insulin dosage to see if she can get along with less.

The one down note after the surgery is that he put in some absorbent material in the cavity where the pus was found and he will have to go back in and remove that probably on Friday. As you know I'm terrible on predicting discharge dates, but I don't think it will be before Monday.

MaryAnn is Home

MaryAnn arrived home early this afternoon.  We both got a course in administering her IV antibiotics.  This could be going on for up to 30 days so we need to get into a routine.  She is pretty tired as you might guess, but very glad to be home.

MaryAnn Status 3/31

Well the time has finally come!!  She's coming home tomorrow.  We're not totally sure of the exact time, but it will probably be later morning or early afternoon.  Obviously she's in sufficiently good shape to be home.  I have been working to get things ready.  For local folks we'll be in touch about help needed.

I am going to stop the daily updates unless something significantly changes.

Hopefully MaryAnn will be able to personally do the next update

MaryAnn Status 3/29

Progress is being made.  Her doctor told her that her white blood cell count was 13000 yesterday - a drop of 2000!  If that trend continues it is good news indeed.  I'm sure the infectious disease doctor will weigh in on Monday.  Our Aaronic Priesthood youth came and gave her the sacrament today.  She certainly appreciated that.  She had another workout from the physical therapist and is making progress there.  Her spirits are great.  She had quite a bit of company today.

Tomorrow should be a day with lots of information and potential decisions.

MaryAnn Status 3/28

We saw two of her three doctors today.  Her internist is concerned that the antibiotic that she is on is not doing the job they would like, so they will probably switch her to a different one. She still runs a low temperature occasionally.  The orthopedist looked at her shoulder and noted that she is healing well from the surgery and the swelling is less.  She continues to walk and do her right shoulder exercises.  Her movements seem to be definitely improving.  She really enjoys phone calls  so take a few minutes and call.

I am going to stop predicting departure days.  When I get told she is going home tomorrow I'll let everyone know.

MaryAnn Status 3/27

Things went well today.  The doctor came in and removed the drain and talked to us for a while.  Everything still looked good.  He feels that it will just take time for the antibiotics to work. He gave an order for her to start physical therapy and that started today.  She did various motions with her right arm for about 10 minutes, which she was able to do without a lot of pain. That will go on every day.  She also went walking for a while today.  The main thing that seems to be keeping her from being discharged is high white blood cell count.  It is still hanging around 15,000 (less than 10,000 is considered normal).  They want the count to start going down which it hasn't yet.  Right now I think the earliest day she could go home is Tuesday.

MaryAnn Status 3/26

The surgery happened today, rather late.  She actually got back into her room at about 7:30.  However, she had a great appetite and ate most of her dinner.  I talked with the surgeon a little while ago and he said everything went as expected.  He cleaned out the shoulder and found a small amount of cloudy liquid, but no pus deposits and no evidence of anything that would require orthopedic surgery.  He put in a drain as planned, which he will take out tomorrow.  She will have her arm in a sling for the next few days, but that is somewhat academic as she had very little use of the right arm anyway.  Physical therapy will start in a few days.  As I've said before the IV antibiotics will go on for quite a while and everyone feels that eventually that will fix the joint problems.  I think we're getting close to discharge, but we'll know better tomorrow.