Naomi’s Life With Arthritis – A Long Term Project
Home alone last night, I was watching the exceptional BBC series “The Genius of Photography“, when I was struck by inspiration. I have felt that I have been lacking a direction in my photography. Suddenly it occurred to me, that I have been ignoring a very important subject, my wife.
Naomi is an exceptional and inspirational person, who has suffered most of her life with the debilitating disease, Juvenile Onset Rheumatoid Arthritis, never more than now. She is currently in hospital, fighting an infection of her prosthetic knee, a complication of the treatment of her disease. With this recent issue, the interest and concern from family and friends has been great, and it has reminded me to varying degrees how little most people understand the disease, and more importantly, what it is like to live with it.
Our family and friends, in particular, generally have a good understanding of what Naomi is going through, but that only goes so far. The general public understands even less. I feel that many people have a poor appreciation of what it is like to experience life with a debilitating chronic disease.
A New Project
I intend to photograph Naomi, and expose what her life is like, living with arthritis. I want to take a journalistic and documentary style, something which I have never really done before. I want to show Naomi’s life as it is, conveying the reality and emotion as clearly as possible. It won’t be art, and it probably won’t be pretty, and I apologise to Naomi in advance if the photos show her in a less than flattering light. However I firmly believe that an unfettered, unfiltered view of this disease is essential. She has given me her consent to undertake this project.
This will be a learning experience for me, and to an extent, I will be exposing myself and my life’s experiences through these photos as well. I will never be able to be truly objective and removed from the subject in the true journalistic sense, as I am very much a part of Naomi’s life, and her disease affects me as well in many ways. I expect this to be a difficult and emotional experience for us both.
I hope that you will find this project interesting and informative, and hopefully I will be able to convey what I think is the most important thing about Naomi’s life with arthritis: the hope and determination this inspirational girl shows every single day of her life.
24th Day in Hospital
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Naomi has surrounded herself with various bits and pieces to make life in hospital more comfortable, and to pass the time creatively and productively.
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A PICC line enters Naomi through her arm and via a vein leads directly inside her heart, allowing for the delivery of antibiotics to fight the infection in her knee.
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Naomi passes the time creatively, by working on a beaded bracelet of her own design.
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Despite the damage to her finger joints, and the swelling and pain that results, Naomi has been able to stay relatively nimble and doesn’t find her beading hobby very restricted by the damage to her hands.
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A nurse administers a dose of intravenous antibiotics, which take from three to five hours to be fed via the PICC line into Naomi’s body. During this time she is tethered to the pump, and must take it with her if she needs to leave bed for any reason.
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Bandages cover an approximately 20cm long wound where Naomi’s knee was opened in surgery to “flush” the joint of infection. The bacteria are able to attach themselves to the prosthetic joint and potentially avoid the antibiotics, leaving a lingering question of how effective the treatment will eventually prove.
For those who are following the saga, the latest news is somewhat mixed. Naomi was expected to be discharged on Monday, to be treated for the next six weeks via “Hospital in the Home” with daily home visits by nursing staff. Unfortunately a test of a key marker for infection (CRP for the medically inclined) just hours before she was planning to leave showed the marker level to have jumped from 15 to 158! This concerned but did not alarm the doctors, but then could not let her go home.
This morning, a follow up test of the same marker showed a minimal decrease to 157, not any better, but no worse either. Naomi suggested that the marker – which indicates inflammation, a typical by-product of infection – may have gone up due to the worsening of her arthritis as a result of needing to come off the drug trial, which she has been on for three years. Her specialist, however, does not believe this is the cause, unfortunately pointing the finger of suspicion back to the infection.
Again the doctors are concerned but not alarmed. This is mostly because Naomi appears otherwise to be in good health, not showing other symptoms one might expect from a bad infection, such as fevers or nausea. For the time being they want to keep her in hospital for observation to see what happens to the CRP levels. They have also given her a moderate increase in her dose of antibiotics.
So for now it’s a waiting game.
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.
The Saga Continues: Naomi Back in Hospital
The poor girl just can’t get a break!
When we last heard from the heroine of our story, she had suffered a stress fracture in her left knee, as a result of using it too much to compensate for her weak right leg which had had a torn quadricep tendon and loosening prosthetic hip joint. Naomi has now been on crutches for about five months, and the toll on her limbs is starting to show. When a swollen lump appeared on her right knee about a month ago, we just shrugged it off as another odd swelling that so commonly happens with her.
This time, however, the lump didn’t go down, it kept growing, and in the last week it had started to become increasingly painful, tight and red. Naomi was planning to ask her specialist about it today when she saw him for her monthly appointment, but a friend in the medical industry saw the knee yesterday and strongly suggested that we get down to the hospital to check it out.
It turns out that the approximately half-tennis ball sized bump was an abscess of maybe 200-300ml of liquid. Today Naomi underwent a 50 minute minor surgery to drain the abscess, take samples for analysis and have a look around with an arthroscope. The doctors aren’t sure yet if the abscess was infected, as Naomi’s arthritis, and the drugs she takes for it, masks the common markers used to identify infection. The good news however, is that there doesn’t seem to be any infection in the prosthetic knee joint itself. If that had been the case, Naomi would likely have had to have her knee removed completely, and replaced with a temporary cement knee joint embedded with antibiotics, for about six weeks, before having that joint removed and replaced again with another brand new knee joint.
So as of now, Naomi is now recovering from the surgery, and in good spirits. It looks like she will need to stay for at least another week, but there are still a lot of uncertainties about the cause of the problem and how long it will take to recover from the surgery. I’ll keep you informed!
Sorry for the brief diversion from photography talk! I’ll try to have another photo related post tomorrow, but as I’m spending most of the day at the hospital at the moment, I can’t promise anything.
It’s been one of those days.
- At August 03, 2008
- By Neil Creek
- In My life
28
This morning our aquarium “crashed”: for some unknown reason, most of the things in our tank died and fouled the tank, putting at risk the rest of the things in our tank.
This afternoon, while on a mission to get an extra filter for the tank, I had a car accident. An elderly female driver entered from a side-street, apparently not seeing me. I was travelling at the legal speed limit, and managed to slow down quite a bit before I hit. It felt like a very hard hit, and both cars were write-offs, but fortunately our injuries were minor.
I was taken to the hospital to be checked out, and was discharged an hour or two later. I’ve got a bumped knee, sore ribs from the seat belt, and a stiff and sore centre and left neck. The doctors said there didn’t seem to be any serious issues, but I can expect to be stiff and sore for the next week or so.
As for the fish tank? We’ve done all we can for now to try and salvage whatever we can, and all we can do now is wait and see. I’m not too hopefull, but sometimes nature can surprise you with how resilliant it is.
I hope to post again soon, especially to get the August project going. I’ll have to wait and see how I feel tomorrow. For now, I’m just going to take it easy. Thank you for your patience!
Update – Photos:
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Here’s the site of the accident:
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