Naomi After Surgery
Flickr Tag Error: Call to display photo '3450216542' failed.
I’m absolutely exhausted after a very long and stressful day, so I won’t say too much now. Only that Naomi’s surgery this morning, to replace her prosthetic hip, seemed to go well, and she is in good spirits and without pain, but still groggy from the anesthetic when I saw her. I am taking photos to document Naomi’s recovery from this surgery as part of a special project that Naomi and I want to work on together. I won’t say more now, but stay tuned for more information. Now I need to crawl into bed…
Flickr Tag Error: Call to display photo '3450216650' failed.
Flickr Tag Error: Call to display photo '3450216722' failed.
Naomi’s Portacath is Flushed by Nurse
During her home recovery from her recent hospital stay, Naomi had daily visits from the Hospital in the Home nurses. During these visits, the nurses would observe Naomi’s vital statistics, such as blood pressure, and change the bag of antibiotic fluid that was being automatically being delivered into Naomi 24/7 by the pump to which she was attached.
In these following photos, which were taken three weeks ago, the nurse also flushed Naomi’s Portacath. This is a small valve implanted in Naomi’s chest, below the skin, with a pipe leading directly into an artery near her heart. This was implanted to allow the nurses easy access to her bloodstream while she was participating in a drug trial. Every month a bag of the trial drug would be given to Naomi through the port, and would allow for blood samples to be easily taken. Part of the care for the port included flushing it monthly with saline solution to keep it clear of blockages.
Since Naomi has been in hospital fighting the infection, she has come off the trial. The port remains, however, while Naomi and her specialist decide what the best new treatment for her will be. Part of the Hospital in the Home nurses’ duties then, was to flush the port when needed.
Flickr Tag Error: Call to display photo '3086270052' failed.
Flickr Tag Error: Call to display photo '3085431881' failed.
Flickr Tag Error: Call to display photo '3085431749' failed.
Naomi has since completed her IV antibiotics course, and is now free of the pump and doesn’t need the inconvenient daily nurse visits. This has been a great relief for both of us! As of today, Naomi is doing well, but is starting to suffer from the effects of the deteriorating prosthetic knee joints which will both need to be replaced early in the new year.
Naomi’s Life With Arthritis – 4 Weeks in Hospital
Flickr Tag Error: Call to display photo '2957394289' failed.
Having her laptop with her has helped keep Naomi sane, especially with the generous loan of my brother-in-law’s mobile broadband dongle. This has helped both of us to shrink the distance by being able to stay in touch all day via chat and email.
Also note here the bruises and red marks on the back of Naomi’s hand. Due to the damage done to her elbows by the arthritis, she is unable to straighten her arms enough for blood to be taken from the usual places. On top of that, due to swelling, inflammation and her drugs, finding a vein suitable for blood tests can be an extremely painful and stressful ordeal – depending on the skill of the nurse. Usually, the best veins can be found in the back of Naomi’s hand.
Flickr Tag Error: Call to display photo '2957394543' failed.
The problem of Naomi’s difficult veins has been helped somewhat by the insertion of the PICC line. This can be used to deliver the antibiotics only, but its placement on her inner upper arm is far more comfortable than the back of her hand. The blue line that enters Naomi’s arm here ends within her heart.
Flickr Tag Error: Call to display photo '2958236572' failed.
As the dose of antibiotics has increased in the last week, Naomi has been suffering from one of the common side-effects: intense itchiness. The itchiness is non-localised, and is enough to distract her from whatever she is doing. For the first time since entering hospital, I have seen Naomi’s spirits suffer. One of the few things she can do for relief is wipe herself with a damp facecloth.
Fortunately the itching comes and goes with the doses, and the nurses have been giving Naomi increasingly powerful antihistamines which are beginning to help, and have reduced the itching to a moderate annoyance.
Flickr Tag Error: Call to display photo '2958236752' failed.
Hospital food is well known for leaving a lot to be desired…
Flickr Tag Error: Call to display photo '2957395121' failed.
…so one of my frequent duties to assist Naomi is an emergency run to the hospital cafe for supplies.
Update
The good news in the last two days has been than Nomi’s CRP – and indicator of infection – has dropped from 150 to 120. This was the reason she wasn’t allowed to return home last Monday as scheduled. Even though the number is high, Naomi has shown no other sign of illness. Now that the CRP has begun to fall she has been given the all-clear to return home.
Now, however, she is waiting for the Hospital in the Home staff to come and fit her with the IV pump that she will carry with her for the next 4-6 weeks while she recovers at home. They are unfortunately severely understaffed, so there’s no telling when they can see Naomi. We are hoping she will come home tomorrow, but it could be longer.
Naomi Update – Ok, So Maybe the Knee Can Stay!
Just a quick update on Nomi while I take a break from my Manifest preparation.
Good news! The surgeons and orthopedics (not osteopaths as I mistakenly said yesterday) people had their meeting, and have decided on a compromise. The options Naomi was given initially were replacing the prosthetic knee twice, with a course of anti-biotics in between, or being on antibiotics for the rest of her life. Both of those are very serious propositions. So the surgeons are instead going to open up her knee, and thoroughly clean and flush the joint out. This is an attempt to remove all of the bacteria which are expected to have formed a protective biofilm against the metal of the joint, where they could hide from antibiotics.
This compromise solution will still require a large incision, probably 15-20cm, into Naomi’s knee, and will require a moderately long recovery. She will be unable to bear weight for 5-7 days, and will need to remain on IV antibiotics continuously for a month. However they feel this is a treatment which has a good chance of removing the infection, without having to go to the extent of replacing the whole joint – twice!
I want to apologise if I worried anyone with yesterday’s blog entry. All of what I said was true, and not exaggerated, but given the despairing mood I was in, I used a tone of voice that may have alarmed some of you. Particularly my comment about scanning Naomi’s heart for the bacteria. On this particular issue, it’s not as serious as it might sound – from my understanding. Apparently the scan is precautionary. It has also been postponed a couple of times, so they are apparently not concerned about it being a pressing issue. Also, if anything of concern WAS found, the treatment would probably be what Naomi is already receiving: strong antibiotics.
So far Naomi hasn’t had this scan, and there’s no set date for it as yet, so we’re just not going to worry about it for the time being. More pressing is the scheduled time for Naomi’s surgery – 3pm tomorrow. This is coincidentally exactly the time I will be photographing one of the costume competitions at Manifest! I hope I’ll be able to keep my concentration.
Tomorrow is going to be a very stressful day for us both, but the day is also an important step forward for us both, paving the way for a brighter future. Naomi will be taking a big step forward to returning to her normal health, and I will be starting my first big professional event photo shoot.
Please wish us both luck! :)
Naomi Update – The Knee Has To Go
Moderately graphic images below, view at your discression.
Today has been a very rough day. I was planning to spend the day shopping and preparing for Manifest after visiting Naomi in hospital first. When I arrived however, Naomi had been given some bad news, so I stayed the day with her.
Unfortunately, upon further investigation and after allowing the bacteria found in the samples taken from Naomi’s knee and blood to grow, it was determined that the abscess on the knee was actually infected. The infection was also found in the joint itself, and in Naomi’s blood. The infection bacteria is Staphylococcus epidermidis
After lots of visits from doctors and specialists from Infectious Diseases and Rheumetology, Naomi was offered a choice: a double knee joint replacement which would result in approximately 12 weeks of recovery, or to be on anti-biotics for life. The surgery seems to be the obvious better choice, but we have to wait to see the result of a big meeting planned tomorrow morning with the Osteopathy department and the surgeons. They will determine what they think is the best course of action for Naomi, given that they are the ones who will have to perform the surgery and look after Naomi. It’s possible that they will determine that surgery isn’t the better choice.
Naomi is also scheduled for an echo cardiogram to check to make sure the infection hasn’t spread to her heart – the organ most at risk due to the fact that all blood passes through it, now that the bacteria has been found in her blood.
Interestingly, the rheumetologist suggested, without actually saying, that the drug trial that Naomi has been on for the last three years may have had an important contributing factor in the infection. The trial, which gave Naomi initially wonderful results in the first year, then increasingly less so in the last two, is an immuno-suppressant. Arthritis is a disease where the body’s own immune system attacks the joints. This trial drug, and all others like it, suppress the immune system to give the body a break. Unfortunately it also lowers it effectiveness at fighting off infection. The doctor suggested that Naomi may not have had as much trouble fighting off the infection herself if she wasn’t in trial. Damned if you do, damned if you don’t.
I’ll let you know how the meeting goes.
Photos below – do not scroll down if you do not want to see moderately graphic images.
Here’s a couple of photos of the nurse changing Naomi’s dressing. After the surgery to drain the abscess, a large hole, about 2cm across, was left in Naomi’s knee. To help the healing process, the hole to the void once filled by the abscess has been packed with about 50cm of gauze. That’s what you can see sticking out of Naomi’s knee in the photos below.
Connect with me online
Recent Comments