Saturday, December 12, 2009

Success, Now What?

The surgery was a success, according to the surgeon. He accomplished what he wanted, to clean out the "goop," his technical term, from the wound and then attach the wound vac. He also took cultures so they can re-evaluate the cooties (my technical term) that are infecting wound and bone to determine if any adjustment of antiobiotics is required.

From the surgeon's perspective, his need to have Skip in the hospital ends following his first change of the wound vac dressing on Monday afternoon. The neurologist has determined her seizure was most likely a one-time event because of the results from the CT scan and EEG, so he has indicated he won't be following her case any longer at this time. The infectious disease doc stopped by yesterday evening while I was visiting. He wanted to find out more about the allergies Skip has to two antibiotics (discovered during a bout of cellulitis almost 2 years ago) because she showed up at the hospital with MRSA as one of the cooties and vancomycin, a key choice in attacking MERSA, is a problem for her.

(Now where did she pick up MRSA? My only guess is that it was introduced by one of the nurses who came into the house. I know they all take care with the use of gloves and hand washing/disinfecting, but that's the logical conclusion as to its source.)

From an infection perspective, the treatment going forward will be a continuing course of IV antibiotics. The current protocol has her receiving them intravenously four times a day. I found out last week that Medicare does not pay for IV administration by a visiting nurse in the home. As a result, it's being recommended that Skip spend a short time in rehab following her hospital release (tentatively scheduled for Tuesday).

The prospect of rehab has Skip sorely depressed. She wants to come home. She misses me, she misses the pups, she misses her home routines. We miss her too. Personally, though, I think rehab for a short time is a good idea. I can learn to administer an IV but I'd like that to be my responsibility at the tail end of this process, not for the long haul. Also, I'd like to see her get a bit stronger so she can do more on her own with her hands before she's left to her devices at home. Finally, I am hopeful she'll get daily physical therapy at a rehab hospital to help get her on the road of building back up her arms and hands. We have to stop the downward spiral of weakness that she's been in lately (I think this is a result of the infection, not an MS symptom).

I gave her my little pep talk about a rehab stay yesterday evening. However, I know it was largely falling on deaf ears. She will be very unhappy about this prospect until it occurs and, perhaps, during the entire time. I am hopeful she can eventually look at this as a time where she can take advantage of the resources available in rehab rather than as a necessary evil to be tolerated until she can get home.

As a backdrop to all of this, is the unfortunate timing. Her birthday is Wednesday and Christmas, normally her favorite time of year, is in less than 2 weeks. It will be a bitter, bitter day for her if Christmas finds her in rehab.

I'm sad for my Skip.


upstater said...

Dear Cranky,
What a rotten week all around. Hopefully the rehab allows day passes (many do) so you can periodically spring Skip while she is on the mend. This is such hard sh*t. You are both in my thoughts and may you each refill your tanks in the weeks ahead.

Herrad said...

Hi Cranky,Hi Skip,
Thinking of you.

Diane J Standiford said...

This sucks. They wanted to send me to rehab last Christmas time; I refused but did end up on an assisted living home, probably for the rest of my life and I SHOULD have gone to rehab---saved MY partner from stress she didn't need and a sick person she couldn't handle alone. I know how much this hurts both your hearts. And people think MS is just something manageable/no big deal...sigh. My heart is heavy for you guys.

CareMan said...
This comment has been removed by a blog administrator.
steve said...

I think you are wise to push for rehab over early discharge. The strength and skills Skip will learn will serve her well when it comes time to come home.

I had to make a similar decision with BR a couple years ago. He was not happy, but both of us learned a lot over his two weeks in skilled nursing rehab.

Anonymous said... undertanding is that MRSA is now pretty much endemic in both health care and community you may never know exactly where it came from.
being in rehab is hard, but even worse is going home too soon and not making as much progress as you can..or ending up back in the hospital and staring all over again!!
hard to do, but swallow the bitter pill now so you can have a much happier Valentines day...or celebrate Christmas when Skip comes home...or some other adaptation.
glad the surgery went so well.

Cranky said...

To everyone - sorry to be slow in responding to your welcome and thoughtful comments. I am in hearty agreement with all of you!

Skip is definitely better served being in rehab. I'm very pleased so far with how things are going there (36 hours and counting). It's also ensuring that she doesn't come home with so much going on that I am crushed.