Wednesday, August 20, 2014

Diary of a Crohn's Flare: Complications

Consistently during my recovery, my heart rate was elevated, sometimes by a lot.

Intermittently over my recovery, I ran a fever.  On one day my fever reached 102 F.

Because I had performed a rapid taper of prednisone prior to surgery, one suspicion was that I was suffering from adrenal insufficiency.  Therefore, they started giving me mega doses of steroids again (not sure of the exact formulation but it was IV steroids).  This resolved my fever and high heart rate for approximately 24 hours.

Then the rapid heart rate and high fever returned.  During one inspection of the surgical wound we noticed the top end of the wound weeping fluid.  So within the hour, the surgeon, physician assistance, and a team of nurses showed up.  They removed my staples and my wound popped open.

At this point in the process I became a bit "creeped out" and stopped paying close attention to the work they performed on my belly :).

My belly with staples.  Note my belly is very bloated from both surgery and from infection. It turns out the discoloration was likely due to infection and not due to surgical scrub or other reasons for skin discoloration:



The surgeon and physician's assistance worked my entire belly, pushing in from the widest point of my waist towards the open wound.  As they worked the skin, pus came out - a lot of pus.  After they finished I asked one of the nurses how much they removed and she stated it was about 100 cc (about 40% of a cup).  This volume is very much greater than the size of the open wound left in my belly which is now (Wednesday 8/20) perhaps 2.5 cm x 2.5 cm x 2.5 cm (the maximum dimensions of the wound are slightly larger than the opening in my skin).  The wound was somewhat larger at the time they first worked on my belly (which was Saturday 8/16).

Since the removal of the staples, they've packed the wound with "open-celled foam" and applied a wound vacuum.  This is supposed to keep any infection drained and stimulate circulation to the affected area.  My particular wound is not weeping very much fluid (perhaps 1 CC per day).

My stomach is still very bloated, however, much of the discoloration has faded.  The wound vacuum has been applied to the open wound (the open wound is under the strip of foam which is under the suction cup).



I finally got discharged from the hospital on Monday 8/18.  The hospital staff treated me very well, but there's no place like home!

I got my wound repacked today (Wednesday 8/20).

Removing the wound vacuum's dressing tape is the most painful part of the process:



Although I do not find the unpacking and packing of the wound especially painful, it does cause pain, it is uncomfortable, I find it a bit creepy, and I find my levels of pain elevated after they finish working on it for a couple of hours.  For these reasons, I have been taking the maximum dosage of my pain medications about an hour before the nurse's arrival in preparation for the procedure.  In the hospital, Valium was included on my list of allowed medications and I asked for a dose of Valium in preparation.  This worked well for me in the hospital, however, I do not have a script for Valium so I just use my pain medications.

I have pictures of the wound after the unpacking from today and I will post that picture later - it's just not readily available at the time of this posting :)



My open wound is very small compared to some (perhaps 2.5 cm .  My complications are very mild compared to some.  I count myself lucky and feel grateful.



I *may* still have some infection in another location of the wound but between keeping an eye on the wound and the wound vacuum we should

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