Infection Caused my Mothers Leg Amputation
My mother got an infection in the bone of her ankle and foot, which is called osteomyelitis, following surgery for an ankle replacement in March, 2004. She had fallen down some steps about 10 years earlier badly twisting her ankle, then had surgery which required a plate and several long screws to repair her ankle.
At this time (2003) my mother was a widow, owned her own home and had a large dog that was in the kennel while she had surgery. My son kept her dog for the whole duration of this long ordeal and I took care of the house, the mail, paid her bills and any others problems that arose.
Circumstances Leading to Surgery
The first surgery served her well for many years but by 2003; she was using a cane all the time and the ankle would just give out on her, which would cause her to fall. I took her to the orthopedic surgeon that August and he recommended an ankle replacement versus ankle fusion because he said it would require less recovery time. However, she had just had a stent put her heart and was on Plavix, so the put the surgery was postponed for several months.
In March 22, 2004 the ankle replacement surgery was done. The doctor had told us the ankle replacement will be cemented in place so she would start physical rehabilitation within a couple of days. Two days following the surgery we were told that the ankle replacement was not cemented in place and that she could not put any weight on her foot for six weeks. He said he talked with some other surgeons prior to her surgery and they advised him not to use the cement, but he didn't bother to tell us. I was more than a little upset to say the least.
Week after week, Problem after problem
As there is so much to the story I'm going to try to shorten it by using dates and main events that happened over the next almost 2 years.
March 29, 2004: Transferred to nursing home. Dr. applied cast prior to transfer. The cast covered the back of the leg and under the foot. The foot and leg was then wrapped with gauze and ace wraps. The cast was crooked from the ankle to the toes, holding her foot at a slight right angle
April 5, 2004: Dressings caused a large blister on bottom of foot, two small toes were black, and large black areas formed around both incisions.
April 14, 2004; Accompanied mother to doctor's office. Purulent drainage noted from lateral incision but was not cultured. Placed on antibiotics. Doctor blamed problem on poor circulation. Mother is not a diabetic nor did she have peripheral vascular disease.
April 28, 2004: Doctor visit. New dressing change orders. Black tissue starting to slough off with drainage. No culture done.
May 14, 2004: Mother discharge to my home with home healthcare wound specialist visits. Wound completely open several inches down to the bone.
June: Mother referred to plastic surgeon for flap or stent graft which he refused to do.
June 10, 2004: Doctor visit and wound cultured at my insistence which grew Methicillin-resistant Staphylococcus aureus (MRSA) infection which is a resistant staph infection. MRSA infections in the bone are difficult to treat.
About June 28th:: Transfer to specialty hospital to continue antibiotics and debridement. Tendon on top of foot drying out, to be removed.
July 7, 2004: New doctor taking over surgery for skin graft. Debridement therapy continues and started on wound vac machine.
July 16, 2004: I called orthopedic doctor about that ankle x-ray needed to allow any weight bearing and if ready she would be discharged my home on July 30 when antibiotics were complete. Wound care would continue with home health again. I spoke at length with the doctor about the difficulties of caring for my mother in a home that is not wheelchair accommodating. He understands I have disabled from lupus and cannot do lifting. He said he would get another X rate let us know the results.
July 17, 2004: Entered hospital for six weeks of IV antibiotics.
July 20, 2004: Orthopedic surgeon performed surgery removing ankle replacement and revised bone with fusion. Left leg now 1”shorter than right.
July 21, 2004: X-ray not done. I called doctors office again and the x-ray was done.
July 22, 2004: X-ray on chart per staff awaiting doctor’s review.
July 26, 2004: Doctor has not seen x-ray. Specialty hospital staff suggests we call Dr. as they cannot change weight-bearing orders, and he has not returned their calls. I called office again. The doctor visited my mother's room for literally 90 seconds and stated weight-bearing could begin.
July 30, 2004: Mother discharged to my home using walker with much difficulty. Remains connected to wound vac. Pain continues to be a major problem.
August 4, 2004: Took mother to wound clinic where re-engineered skin was placed over open wound. No weight-bearing allowed again.
August 11, 2004: Returned to wound clinic numerous times as reengineer skin failed.
August 31, 2004: Admitted to hospital for specialized tests to look for infection. Received a PICC line for six more weeks of antibiotics. Transferred to another nursing home.
September 7, 2005 : She received a new PICC line for two antibiotics as or cultures now included MRSA, Pseudomonas and Enterobactor.
October 18, 2004: Discharged home but unable to complete activities of daily living without constant help and still having much difficulty using walker.
November 9, 2004: Appointment to the orthopedic doctor who suggested removing two screws in her leg to relief pain but ankle not completely healed.
For the next 9 or10 months mother is continually on antibiotics with the draining wound and sees a wound care specialists about every other day, even weekends. Throughout this time our biggest fear was that she would lose her leg and the quality of her life was horrendous.
MRSA Infection Myths and Truths
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During the months leading up to the surgery she put her house on the market and luckily it sold for at a very good price just before the housing market fell apart. At that same time we put an addition on our house, so she'd have her own bedroom, living room and sun room. Our addition on our house was completed and we got her moved the first week of January, 2006.
Decision to Amputate
After much discussion, I finally took her to see a new orthopedic surgeon, who had an excellent reputation to discuss amputation. The infection control doctors had told us that she would never be free from the bone infection. This physician turned out to be a very skilled and knowledgeable doctor. The date for the amputation was set up.
In the second week of January, the family was at the hospital on the day of surgery and the physician came out and prayed with us. I have never been so touched that a physician would be sensitive to the family's needs in this way. The surgery went well and of course my mother had to go back into a physical therapy situation for several weeks to get used to her new prosthesis. The infection was gone!
The amputation was the best thing that could have happened because she got her life back. She got used to her prosthetic but it was slow in the beginning. Now she walks with a cane, drives, gets out of the house to see friends and still plays bridge. She is a remarkably strong woman, as I don’t think I would have held up nearly as well as she did. Sometimes what you think is the worst thing in the world is the only good choice.
I imagine you would be asking yourself at this point how much money did she get from her lawsuit? I did take the information to three different attorneys and none of them were interested in the case. Apparently the laws in Florida are not very kind to the elderly when it comes to lawsuits, as she had not lost any income and that's their criteria. Loss of almost 2 years and constant pain doesn't pay out. Maybe going through a lawsuit would have been one more traumatic event, and it's a moot point now.
It is over six years that my mother has lived with us and it has worked out beautifully. I am so glad she lived through that horrible time and we have had so many special times together. She is 87 and the picture above was taken a year ago. I consider her recovery nothing short of a miracle.
© 2011 Pamela Oglesby
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