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Adventure With Cellulitis

03/30/08

  12:52:09 pm, by Nimble   , 3060 words  
Categories: Journal

Adventure With Cellulitis

On Sunday, one of the scratches on my leg was getting somewhat infected-looking. I had been feeling like I was coming down with something, but it felt like the flu or a cold. I had a sore throat. There was the stress of moving, and a lack of sleep from the dogs joining us after a week of the in-laws graciously taking care of them, to keep them out of the painters' hair.

The wound looked a little ugly, but contained. It was not to remain so, however.

I went to work on Monday, feeling just bagged tired. I attributed it to lack of sleep. It felt like lack of sleep, anyhow. I plodded along at work, working on some simpler visual program bits instead of deep design, but eventually, I just had to give up. In addition to feeling tired, I felt nauseous. I told Keith that I must have mischaracterized what it was. There was a red streak in both directions around the wound on my leg.

I headed home for the first sick day I had taken in... well, I can't remember (apart from the one obligatory for laser eye surgery). I just don't take sick days; I don't require them.

I must have been feeling wretched. I remember how incredibly long the transit rides and waits seemed that day.

When I got home, Dena convinced me to go to the nearby drop-in clinic instead of just passing out. We did. The estimated wait time was about three hours. Fortunately, at this drop-in clinic, we actually got the option of going home and checking in to see where we were in line. That gave me a restless but needed few hours of trying to sleep.

At the three hour mark, we phoned up, and it was still going to be an hour and a half...ish. We phoned up at the hour and ten minute mark and they actually had room for us, so down there we went.

The doctor was nice enough. Not terribly specific on the diagnosis, asked about diabetes (no family history on the one side I know of, never tested positive - it's important to know because diabetes makes for sores and poor circulation sometimes). Gave me a choice of antibiotics: the slower, penicillin-derived one, or the more fast-acting but expensive one, Biaxin. I was desperate to make sure the infection was arrested, so I opted for Biaxin, and took it as soon as possible.

Biaxin was to be taken in a two-tablet-per-dose one-dose-per-24-hours format. I must say, when things are not improving, the remaining many hours before you can take your next dose and just feel you are doing something about the infection can be pretty frustrating. I was already limping around a bit - it was sore, and I had a headache and earache. Headaches are an extremely uncommon occurrence with me. This was bad.

I also got a sheet for getting two lab tests done. I asked him to add something for diabetes, so he put Glucose - Random on the sheet, which is nice, because it does not require fasting.

The next day, there was red rash all around my shin, and a nasty side-effect: putting weight on the left leg would start sore and then start tightening up and ramping up in pain. I just couldn't get up: a few seconds and the whole leg would scream agony at me. Repeated attempts would eventually find a tolerable way to stand. It became apparent that I wasn't going into work.

Dena took me to the closest lab services we have: South Centre mall. Short line to get registered, quite a bit longer of a wait to actually get in and get your blood drawn, but eventually got in. I left my copy of How Brains Make Up Their Minds behind for only the first time in this adventure.

One understandable but still worrisome thing that walk-in medical clinics do here: "we'll phone you if something's wrong - if you don't hear from us, then there was nothing really unusual".

Dena wanted to take me to emergency later that day, but I made a deal with her: one more dose with the Biaxin, and if I still was not showing any signs of improvement, then we would go to emergency in the morning. I had looked up what such an infection could be that day, and determined that it was in all likelihood cellulitis - the pictures matched approximately as well. It was the CNN Health Library entry that convinced me that I wouldn't be wasting their time down in the emergency ward.


Morning it was. Actually, early morning, pre-6 am. Feeling just as bad, red margins spreading. Dena drove me off to the Rockyview. There were an astounding number of people on the road already.

The admitting room was not incredibly full, but that usually belies the wait that you are in for. The triage nurse was downright knowledgeable: she recognized the symptoms and asked all the right questions. Most importantly, she assured me that it was a good idea to have come down there.

I got my armband from the admitting window not too long later, but the sun was up and in our eyes (just before which we moved) quite a bit before I got called in. Dena and Axel could not, unfortunately, accompany me in, and there are no mobile phones allowed, so she ended up having to operate in a vacuum (no, not space surgery) as to what was going on.

I got changed into the hospital gown in the bathroom and put my clothes into the garment bag provided. It was pretty much an examination chair in a hallway - there were quite a few other patients in the area. They were going to move me to a room for examination, but I had made the mistake of putting my leg up, and it was now even worse to try putting it down on the ground. So they checked things out first in the hall, and the female doctor drew the outline of the red area on the leg (it was now almost up to the knee in front, and quite lacerated-looking in the back).

Just my luck to get a male nurse! Ah, I kid - I don't care what gender they are; I'm no bachelor :) I didn't catch his name, though, but he looked like an older, rough-but-pleasant Italian guy. After getting all my information - including blood pressure again (one thing I found odd about the whole experience was how every single place I went would take my blood pressure - I guess it's easier than trying to locate it in the faxes or online data, I suppose) He brought a wheelchair out so that I could basically climb from the examination chair.

My heart rate was in the high 80s/low 90s, which is very high for me, but they said it was to be expected.

I left behind How Brains Make Up Their Minds for a second time, but they retrieved it for me.

In the room, I awaited the process for getting an IV, because it was really important to get some IV antibiotics in me as soon as possible.

The male nurse tried finding a vein, but he was having a hell of a time. Not his fault, really - I have shy veins. He went from side to side, I made a fist when asked, he found some heated towels to throw over both arms, and went to get the big guns.

The big guns, of course, was a charming, experienced gal who just had her tricks, and they mostly just consisted of short, directed slapping and flicking (as in the same way one would flick marbles) of the target vein area. That worked, though I ended up with an IV right there in my right hand. Beggars, choosers, yes, I know.

The IV site goes in, they tape it down. There's a little blue clip in the apparatus which basically just either lets the tube be open or closed. Up a little ways on your arm they screw another tube into the short IV tube, tape them together, and tape that to your arm. This tube has a little Y connector where I guess other things can be injected in should they need to. Further up from that is the medical equivalent of a Spirovent: it removes gas from the line.

I was given a quick blood sugar test, and it was high: 9.4 when it should normally be in the 3.3 - 7.0 range.

I don't know if this explained the weird aversion to sweets I had been having (ask Dena: I turned into a savoury fiend). The nurse was a bit concerned, but I guess he figured anything would come back in testing.

Since their priority is to keep beds free, and they have the technology, I was allowed to get dressed (ouch - note to self: next time, parachute pants) and they then gave me directions to the HTPT ward. I can't recall... or perhaps never found out... what HTPT stood for, but the Home IV program is there.


Dena and Axel were still waiting for me when I came out in a wheelchair. We made our way there. I was starting to get a little bit arm-tired, so Dena, Axel and I made a train: Dena pushed me and I pushed Axel. It was only later in the HTPT clinic that one of the people on-duty there found out that my all-too-brief wheelchair education had not included... how to turn off the wheelchair brakes.

More waiting was in store in the Home IV clinic, of course, but I eventually got my turn. First they... well, they took my blood pressure again. That nurse was pretty salt-of-the-earth, which is good, really. She couldn't push me in my wheelchair, though - she was still getting physio for her shoulder.

The doctor (a male doctor this time) came in, prescribed just the very basic antibiotics, once again asked about diabetes, once again was nice but not too full of information to pass along.

I got into a more communal room where people were being fit for IVs. Not a huge room - maybe seating for five, but preferable to sitting in a room on your own not knowing what's going on. One of the nurses there set me up on the home IV unit.

The unit is a Hospira Gemstar Blue and you sign off for a replacement value of $3500 for this little puppy.

The IV tube goes through a cassette in the unit, which pumps small amounts of liquid through at a time by, from the looks of it (it's delivering medication right now - it's my 5 pm infusion), pulling and pushing a metal piece into the side of the clear plastic cassette. At the other end of the cassette, the tube continues to a pointy bit that gets stuck into the bag of antibiotics or what have you.

It's programmable for rates, doses and times.

It doesn't require gravity operation, so you don't have to hang it from anything, and you don't even have to make sure your hand never slopes up. This is a relief coming from dealing with that infernal beeping, screeching gravity-fed IV unit after Dena's C-section.

I was given two bags of Cefazolin 6 g. It is apparently pretty effective against the kinds of bacteria that typically cause cellulitis, and furthermore, it's fairly cheap: $9 per IV bag. The bag lasts through three doses, and they programmed the Gemstar to give them every eight hours starting at 5 pm (since I had already been infused in emergency). The crash course on replacing the bag and handling problems was pretty good - they even had me demonstrate replacing a bag with a sample spike and sample bags. Some advice was simple but good, e.g. poke the new bag when it's upside-down with the tube facing up, or you may have a mess on your hands.

They gave me Tylenol-3s. It still seems to be the case, unfortunately, that analgesics like Tylenol have no pain-reducing effect for me. Stupid biochemistry.

They did advise me to take the Tylenol for anti-inflammatory purposes, though, so I tried to be sure to take them.


At last, we got back home, some 9-10 hours after our morning departure.

Things still felt sore and the redness was spreading even on the next four doses. I got the impression that the hospital personnel were expecting it to clear up faster than that, but that an initial spreading might happen as the subsurface infections started to show reaction on the surface. Still, I no longer had a headache, so despite all the hurt, it felt better just to be able to think again. I even managed to help out by remote for a couple of hours at work on Thursday.

Dose five finally started actually feeling better. I could actually get up on the foot. I could feel the tensing and ouching happen, but it was slower. Some of the reds had turned to yellows. Good?


By the time of the Friday 11:15 am appointment, though, it was clear that even though I was feeling better, this was not going to be a visit just to take out the IV.

Indeed, it was not, but I could walk, and for that, I was very happy.

When it was my turn, I got to sit in a room alone for quite a while (if only I had brought my book along with me this time!), see the same good-natured but relatively uninformative doctor said, yes, we'll keep you on antibiotics until Monday, and then back to the communal room with the IVs where they re-sited my IV to my left hand. My pulse rate was down a bit, to the high 70s, which was a mild relief.

I went to pay for the antibiotics this time. It almost seems that if they poke the bag, you get it for "free", but if it's a take-home bag, you have to pay for it. Anyhow, I tried paying with my card, and I got a rejection back.

Huh??

It actually came up and said "Card canceled". Now for a quick and total aside:

Dena actually got phoned up by CIBC this past week, and they said that Dena needed to go to an ATM and redo her PIN, because a store where she used her card was under investigation for debit card fraud - I don't know, somebody swiping the cards into a second machine, what have you. They would not - sounded like could not - give out any information on who was under investigation.

I phoned up TD, and it turned out that my card was canceled for the same reason.

I do not know how recent this is, but here are the last several places I have used my card: Deer Valley Shopper's Drug Mart, Deer Valley Zellers, Southland Rona, South Centre Sears, Deer Valley Mac's, Deer Point [Gdn] Sobey's, Deer Valley Dairy Queen, 32nd Avenue Staples.

It could have been before that, but just in case this list intersects with that of anyone else in Calgary having the same troubles... I want to help nail these asshats.

Now I can type and mouse a bit better, and I am now on my last bag of three additional ones. I hope I can switch from IV to oral antibiotics at the very least, but we will see Monday morning.

One slightly funny aside: we have been in the process of moving from one house to the other, but we now stay here at the new place. I have not yet informed work of this, but I figured that would be okay, since I can certainly pick up any mail.

I was not counting on a bouquet from work, though. *slaps forehead* It was left out overnight by the florist at our old townhome. My in-laws discovered this when checking on things at the old place. The bouquet is somewhat the worse for wear, apparently. Doh :) Some hardy plants still live on, though, so that is good.

I will post any additional updates.

Thank you, Science. Thank you, wife!

Thank you, Science Wife!

...and thanks for all the well-wishes from my buddies, family and acquaintances throughout this :)


UPDATE: On Monday morning just before 5:30 am (gah), the IV unit started blaring out an error code "09/016/129". The toll-free number listed... just went to the hospital itself. The "Silence" button on the unit was strangely inoperative, so I ended up just having to power it off. The on-duty nurse was in at 7:30 am when I phoned, but they had no idea about the error message, either, and advised me just to turn it off (which I had) and bring it along.

Google searches for error codes for the GemStar found nothing.

Missed a dose, all in all.

Went in for a 9:15 am appointment, but it was hours before I got in. A lot of traffic coming up from emergency, from the sounds of it. Keith had an amusing thought: the hour that people turned off their lights for Earth Hour ended up with a lot of people taking tumbles :)

The leg was not better enough to be taken off IV antibiotics yet, though it was certainly a lot better compared to Friday.

They had to re-site the IV again, and I was really running out of surface veins, from the looks of it. It took nearly an hour to finally get an IV sited, and not for lack of trying: there were three "misses" as well.

I don't think I want to get sick again :)

I'm glad that they decided to trade GemStar units instead of just resetting the one I had. Just felt better being sent off with a unit that did not have a weird blaring mystery error :)

One of the female patients who was there on Friday was there again on Monday. Turned out that she was also there for IV antibiotics for exactly the same kind of thing, based on her symptoms - she just didn't know that it was cellulitis.

A word of warning for latecomers: she was about seven minutes late for her appointed time, even though the clnic were already running over an hour behind. Just being late in the first place lost her her appointed time. Slackers beware :)

5 comments

Comment from: Adam [Member]  
Adam

Get well soon :)

03/30/08 @ 23:26
Comment from: ElTwo [Visitor]  
ElTwo

Wow. That is quite an adventure alright. A spreading of the affected area is definitely a big warning sign. Good to hear it’s getting better. Do you remember what gave you the initial scratch?

04/01/08 @ 18:03
Comment from: Nimble [Member]  
Nimble

Get well soon :)

I will try :)

Wow. That is quite an adventure alright. A spreading of the affected area is definitely a big warning sign. Good to hear it’s getting better. Do you remember what gave you the initial scratch?

I don’t remember where the initial scratch came from. I think (but I’m not positive; it’s been a bleary month) I was clearing up all the dog crap left by the previous house owner, on top of various bits of wood and whatnot. I may or may not have been scratched by something there.

Just pleased that things are slowly clearing up :)

P.S. I added an update to the story

04/01/08 @ 22:27
Comment from: dena [Member]  
dena

Add in that you thought you initially had the flu on the Monday you came home from work… you really had the chills and were tossing and turning in bed, despite in actuality being really, really warm– you were radiating heat!

My hindsight to this surging up was how you were all “temperature wrong” on the weekend before. Mostly you were feeling overheated, even in our currently cool basement, and kept uncovering the baby “in case he was too warm"! *laugh!* Some projection going on there… ;)

Glad you are doing so much better now– it has not been fun to see you ailing like this. :(

I want you to be hale, hearty and healthy! :D

04/01/08 @ 23:10
Comment from: John Williams [Visitor]
John Williams

What doctors tell you about cause? Often it is insect or spider bite? I’m glad that you are better but you must take care about prevention of recurrence. Try read something about that, it will help to avoid recurrunce (it is up to 50% in some types of infections).

09/23/10 @ 13:20