Osteo Again?

There are some trends emerging for Skip that may indicate osteomyelitis (bone infection) is back or was never really eradicated while in the hospital/rehab. At Skip's last wound care center visit, the tunnel in her wound, which is really the only significant part left, had actually lengthened, increasing in length by 20% from the visit 2 weeks prior. This tunnel is what had exposed the bone to infection in the first place, as I understand it. The fact that it's been resistant to shrinkage and now has grown could be a sign of infection. In addition, she had a blood test that indicates she does have an infection somewhere. Yesterday, I took her to the hospital to have an x-ray. The infectious disease doc that we saw at the wound clinic ordered this. He said an MRI can show evidence of a bone infection for a long time after it's been wiped out; the x-ray will show if there's been bone loss. I suspect he'll read the x-ray on Monday and I hope we hear something definitive right away.

The prospect of osteo has Skip worried. I don't think I'd characterize how I feel as worried, but I am a bit concerned about what's required to wipe it out if the diagnosis is osteomyelitis and how that will affect our current, stable status. We'd be looking at another month-long course of IV antibiotics. Medicare, for some unfathomable reason, does not pay for home infusion! How misguided is that? What, they want to send someone like Skip who only needs IV antibiotics to an acute rehab hospital, pay for the care there, expose her to other infections where instead she could be treated at home with me doing most of the IV administration? I understand there are some ways to work around this Medicare constraint, but we'll have to cross that bridge when we get to it.

So let's assume we can do the IV at home. She'd have to have a PICC line inserted, and I expect that would be done in a fairly sterile hospital setting. Then, someone would have to train me on the infusion approach, including troubleshooting and when to determine the problem can't be solved by me and I need to get a pro in. Then, I presume she'd have to get the drugs administered twice a day for 28 days (this was the course used at the hospital). I expect there'd be complications, as she had them in rehab. The PICC line had to be replaced twice, or even three times, during the 4 week period.

Part of me is sort of interested in learning how to do this as I expect most of the time, it's very straightforward to administer IV's at home. Another part, though, is concerned about how much of a time eater this could be. We'll definitely have to work out a schedule of administration that is outside of work hours, which shouldn't be difficult.

Well, perhaps all this ruminating by me is unnecessary. Maybe the doc will call on Monday and say all is well. But as a character in a favorite childhood book, The Phantom Toolbooth, said: "expect the unexpected and the unexpected never happens."