Naomi – The Worst Day Yet
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Two days after the surgery to replace her prosthetic hip, Naomi suffered through the most painful and difficult day recovering from any of her surgeries. After having remained in bed continuously for two days, since the surgery, the physios and Naomi both wanted her to get out of bed to move around a little. Due to the almost complete blocking of sensation due to the epidural, the physio wanted to take Naomi off the drug, so that she would have some sensation in her legs when she stood up. Unfortunately, it seems it was too soon to cut this pain relief, and as a result, transferring from the bed to a chair and back was equal to the most painful thing Naomi had ever felt. Even sitting in the chair was so painful, Naomi could only manage it for 40 minutes, in agony the whole time.
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After a brief sit out of bed (top), Naomi transfers back to her bed, assisted by a frame and two nurses, the pain clearly visible on her face.
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Moving around and exerting herself partially opened up the approximately 33cm (13in) wound, requiring additional bandaging.
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Even after returning to bed and being given high doses of oral painkillers, the pain was too severe for Naomi to tolerate. Mercifully, the nurses resumed the powerful epidural drug that completely blocked all pain from the lower back down. The change in Naomi’s disposition was like night and day, within a mere 10 minutes of the reinstatement of the epidural. Seen here at the lower left is the patch and bandage on Naomi’s back where the epidural enters her spine, to deliver the drugs. The bloody bandage at upper right covers the surgery wound.
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The following day, the epidural had to come out permanently, or risk infection. Fortunately a good alternative was available. Naomi was given a PCA (patient controlled analgesia), an IV painkiller that Naomi can control herself with a button whenever the pain becomes too severe. There is a limit of one dosage every five minutes. Naomi was using it to its limit, but was gaining significantly better pain control than the previous day – though not quite enough for comfort.
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Due to her immobility and the swelling in her right leg, Naomi is required to wear a “TED” stocking, to help prevent the occurrence of a deep vein thrombosis, or DVT.
Fortunately, and to our great relief, Naomi’s condition today (day 4) is much improved on the days described above. With an extra day’s healing, a doubling of the dosage given via the PCA and a short but very productive physiotherapy session today, Naomi’s pain is at a much more manageable level and she is actually able to enjoy some measure of comfort. I plan to visit Naomi earlier in the day tomorrow to hopefully photograph her doing a physiotherapy session.
Naomi After Surgery
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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…
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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.
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.
Recovering at Home
Hi everyone
It’s Naomi here, Neil’s wife who he has been blogging about this week. First of all thank you for everyone’s kind thoughts and well wishes – it’s wonderful to get these from people I don’t even know! I thought you would like a brief update on my situation (it’s always hard writing about yourself).
Neil mentioned that I had a bone scan at the hospital, which was ok, except for the numerous painful attempts at trying to find a vein to put the dye into (I have tiny veins, which makes it hard – but I do have a port-a-cath which they should have used – but that’s a whole other story). This was completed and I had to then wait for the head orthopaedic doctor to look at it before they would give me a diagnosis. I also had to wait for some more blood tests as they lost one of the vials and had to re-take the blood – oh joy! So as a result had to stay another night in there.
Late on Friday arvo they told me that my hip prosthesis has started to loosen (as they suspected). I have had the replacement joint for at least 10 years (which is what their approximate life span is). You can see with the photo below what the prostheses look like. (Neil had to have a photo :P ) I have had both done, but the left is still feeling pretty good.
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So I was allowed to go home on Friday evening which was great. Since then I have been getting better VERY slowly each day, with less pain and more movement. I am unable to walk unaided still and am using a combination of different crutches and a wheelchair for going to appointments etc. I did hydrotherapy yesterday which was great and I felt fabulous after it with me being able to walk a few steps unaided. Today I am a bit sore which was expected. I also went to physio’ today which was good. It was more of an assessment, but she gave me some new comfy crutches and some great tips for getting up from a bed (which I have not been able to do).
So that’s it so far. I am having the rest of the week off work, and will re-assess things next Monday. I have an ortho’ appointment on April 22nd where we will discuss if it needs operating on soon or not.
Thanks again to my loving husband Neil, who is there for me all the time and is just wonderful. The poor thing has not had much sleep so his lack of blogging is partly my fault (sorry to all of his subscribers). Hopefully I will not need to rely on him as much in the coming weeks and he can get back to his normal daily life too.
Love Naomi xx
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