The treatment for the cellulitis turned out to be intravenous antibiotics for a week which thankfully were administered by home care (after the initial dose as an in-patient).
It's quite the undertaking - two plus hours a night sitting with a drip; then disconnecting tubing while leaving the needle in and hoping that the site will last another day. If it doesn't then it's another go around with the nurse the next night to find a suitable site and tape everything in place.
The morning shower becomes an interesting undertaking. I was advised to cover the leg wound in Saran Wrap. Then I had to cover the needle site in Saran Wrap. Apart from requiring an industrial sized roll of Saran, I entered the shower every morning looking like something from a David Cronenberg film and emerged a soggy, dripping mess.
The treatment however was very effective. The antibiotic they used was heavy duty and my leg was feeling better within three days.
Never having had home care before I was impressed with the service. Someone arrived ahead of the nurse with boxes of stuff and a IV pole and an IV machine to meter the drip.
The nurses I had (2) were very different and diverse. Both had been here 8 years - one was an Iranian who was a trained nurse back home. The relief guy on the weekend was an Angolan-trained pediatrician of some 4 years standing who was interning here as a pediatrician to gain his Canadian qualifications. All of which made for some interesting discussions.
The wound itself is shrinking - but very slowly. It will be 7 weeks this Sunday since the injury and at this rate it will take several more weeks before I can say it's really healed.
Thursday, October 23, 2008
Wednesday, October 8, 2008
Fixing the Hole in My Leg
I felt such an idiot for tripping and falling into the door handle of the car on September 7th that I didn't post anything here about the accident.
It is a nasty wound, about 2 inches by 1 inch and shaped like a crescent moon. It is also deep because I rubbed my trouser leg when it happened and all the skin and flesh came off on the inside of my pants. I thought it would heal, albeit slowly, and the emergency folks at Toronto General said there was no skin left to stitch so here's a tetanus shot, dress it daily and be prepared for a long healing process.
That was 4 weeks ago and it isn't much better. Not only that, an infection has spread up my leg through the lymph system causing sore, red blotches and making it difficult and painful to walk. So after a quick visit to my family doctor yesterday it was back to for a second time to TGH emergency last night where they told me it was cellulitis and ordered up an intravenous antibiotic. (My average wait time at TGH emerg is now 5.25 hours)
The transplant team also swung into action today and are considering a coordinated intervention that might include broader coverage on the antibiotic front, wound cleansing - can't wait for that! - and plastic surgery. My guess is I won't be chosen for a transplant even if something comes available until this infection and wound are cleared up.
So moral of the story for me is call for help early and don't assume things will get better on their own.
It is a nasty wound, about 2 inches by 1 inch and shaped like a crescent moon. It is also deep because I rubbed my trouser leg when it happened and all the skin and flesh came off on the inside of my pants. I thought it would heal, albeit slowly, and the emergency folks at Toronto General said there was no skin left to stitch so here's a tetanus shot, dress it daily and be prepared for a long healing process.
That was 4 weeks ago and it isn't much better. Not only that, an infection has spread up my leg through the lymph system causing sore, red blotches and making it difficult and painful to walk. So after a quick visit to my family doctor yesterday it was back to for a second time to TGH emergency last night where they told me it was cellulitis and ordered up an intravenous antibiotic. (My average wait time at TGH emerg is now 5.25 hours)
The transplant team also swung into action today and are considering a coordinated intervention that might include broader coverage on the antibiotic front, wound cleansing - can't wait for that! - and plastic surgery. My guess is I won't be chosen for a transplant even if something comes available until this infection and wound are cleared up.
So moral of the story for me is call for help early and don't assume things will get better on their own.
Thursday, September 25, 2008
Status Change
In the transplant program here in Toronto each wait-listed person is classified as either Status 1 or Status 2. I have been Status 1 up till now - which I believe means relatively stable and less urgent.
As a result of my last 6 minute walk test my status has been changed to a 2. Practically speaking that means if a lung becomes available that fits two candidates - a Status 1 and a Status 2 person - the Status 2 person gets it. So this comes under the category of good news bad news. Good news that I have a degree of advanced standing and bad news that I'm getting worse and need it!
As a result of my last 6 minute walk test my status has been changed to a 2. Practically speaking that means if a lung becomes available that fits two candidates - a Status 1 and a Status 2 person - the Status 2 person gets it. So this comes under the category of good news bad news. Good news that I have a degree of advanced standing and bad news that I'm getting worse and need it!
Sunday, September 14, 2008
Graduating to a Mask in time for Halloween
I've mentioned before the contrasting affects of my improved level of fitness over the last 12 weeks set against my invetable declining lung capability.
One result is that I have had to start using a mask instead of the nasal canulae when I use the treadmill and the bike. Most people, me included, breathe through the mouth when exercising and that cuts down on the oxygen that comes through my nose. The mask concentrates the supplemental oxygen and keeps my oxygen/blood saturation much higher. As a result I can exercise longer and feel less tired at the end of the session.
Wearing a mask cuts down on conversation unless the person you re talking to is used to interpreting muffled wheezes so that's also a benefit. It's suprising how much talking while exercising reduces my numbers.
One result is that I have had to start using a mask instead of the nasal canulae when I use the treadmill and the bike. Most people, me included, breathe through the mouth when exercising and that cuts down on the oxygen that comes through my nose. The mask concentrates the supplemental oxygen and keeps my oxygen/blood saturation much higher. As a result I can exercise longer and feel less tired at the end of the session.
Wearing a mask cuts down on conversation unless the person you re talking to is used to interpreting muffled wheezes so that's also a benefit. It's suprising how much talking while exercising reduces my numbers.
Friday, September 12, 2008
Delroy the Delivery Guy
Every Wednesday and Thursday Delroy tops up my oxygen tanks - the big base tanks of liquid oxygen that sit in my office and at home. This can't be easy work given the size of these things, the rigamorole he goes through to get the office tank up to the 16th floor of BCE Place and the fact that he is working with a liquid at minus 183 degrees Celcius.
Delroy looks a fair bit lighter that the tanks are but he is ever cheerful and, as it turns out, not just interested in getting me oxygen on time but is also very concerned about how his "patients" are doing.
The other day he called ahead as usual and asked how I was doing and I responded that I was half empty and needed a fill up. Turns out he really meant "how was I doing?" and encouraged me to keep positive and keep active. Apparently he regularly reminds his patients of this. Great delivery guy!
Delroy looks a fair bit lighter that the tanks are but he is ever cheerful and, as it turns out, not just interested in getting me oxygen on time but is also very concerned about how his "patients" are doing.
The other day he called ahead as usual and asked how I was doing and I responded that I was half empty and needed a fill up. Turns out he really meant "how was I doing?" and encouraged me to keep positive and keep active. Apparently he regularly reminds his patients of this. Great delivery guy!
Thursday, August 21, 2008
Two Fascinating Pilot Studies
One of the challenges with lung transplants is the low percentage of available lungs that are eventually transplanted. World-wide that percentage is only 15%. In Toronto it's higher but still below 35%. By contrast, that number for kidneys is 70%.
Toronto General Hospital is a world leader in trying to improve that percentage by both improving the preservation and preparation of suitable lungs prior to implant and by "recondtioning" lungs that don't meet all the standard criteria for acceptance.
A new technique using Ex Vivo (outside the body) Lung Perfusion is being tested in Toronto and all the patients on the list are being invited to participate in two studies.
The ex-vivo technique involves removing the lungs and ventilating them with a machine while perfusing them to cleanse them and help the lungs to repair damage naturally. This is all done at body temperature which is a big difference from current procedure. At the moment lungs once they are removed are preserved awaiting implantation in 4 degree solution. This shuts down cellular activity and prevents natural regeneraton and repair.
The first study of three patients involves bi-lateral transplants where one lung is preserved the usual way in 4 degree solution and the second is perfused at body temp for 2 to 4 hours before implantation. They will then see if there are any differences between the two lungs that shows perfusion improves acceptance and healing.
The second of 22 patients involves using lungs that don't meet current standards and perfusing them at room temp to see if they come up to standards. If they do they are used. If not they are discarded.
This opens up a potential whole new world of reconditioning body parts or a kind of "body shop".
The video we were shown was quite fascinating. The naked lungs sit in a glass or plastic bubble device looking all the world like a large turkey hooked up to a ventilation tube. They "breathe" as the perfiusion takes place and apparently 2 to 4 hours are required to demonstrate that the perfusion has worked or has failed to improve lung functioning.
TGH is a leader in this technology and we are all excited by the possibilities it opens up - better implantation results and a larger supply of potential lungs.
At the personal level it means that if I am accepted into one of the trials, it will improve my chances of getting a transplant earlier.
The first trial of 3 seems to me to be less risky than the larger trial. In the first trial they will be using fully acceptable lungs and just preserving them using two different techniques. In the larger trial they are using sub-par lungs that have been reconditioned and there is a chance that reconditioned lungs that look OK after perfusion still fail after implantation. So we have a decision to make after we review all the details and talk to the doctors.
Toronto General Hospital is a world leader in trying to improve that percentage by both improving the preservation and preparation of suitable lungs prior to implant and by "recondtioning" lungs that don't meet all the standard criteria for acceptance.
A new technique using Ex Vivo (outside the body) Lung Perfusion is being tested in Toronto and all the patients on the list are being invited to participate in two studies.
The ex-vivo technique involves removing the lungs and ventilating them with a machine while perfusing them to cleanse them and help the lungs to repair damage naturally. This is all done at body temperature which is a big difference from current procedure. At the moment lungs once they are removed are preserved awaiting implantation in 4 degree solution. This shuts down cellular activity and prevents natural regeneraton and repair.
The first study of three patients involves bi-lateral transplants where one lung is preserved the usual way in 4 degree solution and the second is perfused at body temp for 2 to 4 hours before implantation. They will then see if there are any differences between the two lungs that shows perfusion improves acceptance and healing.
The second of 22 patients involves using lungs that don't meet current standards and perfusing them at room temp to see if they come up to standards. If they do they are used. If not they are discarded.
This opens up a potential whole new world of reconditioning body parts or a kind of "body shop".
The video we were shown was quite fascinating. The naked lungs sit in a glass or plastic bubble device looking all the world like a large turkey hooked up to a ventilation tube. They "breathe" as the perfiusion takes place and apparently 2 to 4 hours are required to demonstrate that the perfusion has worked or has failed to improve lung functioning.
TGH is a leader in this technology and we are all excited by the possibilities it opens up - better implantation results and a larger supply of potential lungs.
At the personal level it means that if I am accepted into one of the trials, it will improve my chances of getting a transplant earlier.
The first trial of 3 seems to me to be less risky than the larger trial. In the first trial they will be using fully acceptable lungs and just preserving them using two different techniques. In the larger trial they are using sub-par lungs that have been reconditioned and there is a chance that reconditioned lungs that look OK after perfusion still fail after implantation. So we have a decision to make after we review all the details and talk to the doctors.
Thursday, August 14, 2008
A Two-Tank Party
It's been a hectic two weeks and I haven't entered anything here for some time. We have had first one sister arrive from England then my second sister with their respective husbands for overlapping holidays. Our 30th Wedding Anniversary celebration fell in the middle of all of this and we had what I'm calling a Two-Tank Party on August 4th arranged by my sisters and our daughters - 2 tanks because that's what it took in oxygen to get through the festivities.
We were joined by many friends and family - those who were in town for the long weekend and those who came back early - and it was great to see everyone. As a result of many fine gifts, I think I have figured out the empirical relationship between consumption of single malt scotch and oxygen saturation levels - one dram per 1.5 percentage points - I'll leave it to you to figure whether the effect is positive or negative.
Life goes back to somewhat normal tomorrow - back to a two/three person household instead of 8 - and then it's a short slide to Labour Day and cooler weather.
I'm in my 9th week and starting the third month on The List. During the last three weeks it has been a tremendous help to have my sisters and their husbands come to physio and help with set up, wipe down of the equipment etc. I can skate through the propgram in about two hours with assistance whereas it takes about an extra 30 minutes on my own. Stephanie and Anne-Marie will take over when my last sister leaves to go back to the U.K.
The novelty of physio has worn off a bit and I know it will seem more of a grind as the Fall appoaches. On the plus side I am feeling much fitter and I'm up to 1.8 miles an hour for 20 minutes on the treadmill and tension 5 - whatever that means - on the bike. I'm also using weights more for leg and hip exercises so the program is having a positive impact on my level of fitness and general well being.
I think the number of transplants being performed has increased after what seemed to be a quiet Spring. That always is good for a lot of water cooler speculation in the Treadmill Room and adds to the buzz and general feeling of anticipation in the air so we are all hopeful. A good way to shift from summer to fall mode.
We were joined by many friends and family - those who were in town for the long weekend and those who came back early - and it was great to see everyone. As a result of many fine gifts, I think I have figured out the empirical relationship between consumption of single malt scotch and oxygen saturation levels - one dram per 1.5 percentage points - I'll leave it to you to figure whether the effect is positive or negative.
Life goes back to somewhat normal tomorrow - back to a two/three person household instead of 8 - and then it's a short slide to Labour Day and cooler weather.
I'm in my 9th week and starting the third month on The List. During the last three weeks it has been a tremendous help to have my sisters and their husbands come to physio and help with set up, wipe down of the equipment etc. I can skate through the propgram in about two hours with assistance whereas it takes about an extra 30 minutes on my own. Stephanie and Anne-Marie will take over when my last sister leaves to go back to the U.K.
The novelty of physio has worn off a bit and I know it will seem more of a grind as the Fall appoaches. On the plus side I am feeling much fitter and I'm up to 1.8 miles an hour for 20 minutes on the treadmill and tension 5 - whatever that means - on the bike. I'm also using weights more for leg and hip exercises so the program is having a positive impact on my level of fitness and general well being.
I think the number of transplants being performed has increased after what seemed to be a quiet Spring. That always is good for a lot of water cooler speculation in the Treadmill Room and adds to the buzz and general feeling of anticipation in the air so we are all hopeful. A good way to shift from summer to fall mode.
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