I have a bed sore, and the pelvis bone is infected. What to do?
I'll explain my situation so that way you know what happened, where I've been, and who I've seen.
I am a C-5, C-6 quadriplegic and have been paralyzed since September 99. Back in December 06, my parents noticed several small tiny holes. They started getting bigger, and it looked like a sore was starting. At first my local doctor thought it was an infection, so they tried antibiotics and medicine but after that didn't work it was getting worse. So, on New Year's eve I went to the hospital where they opened the wound more in order to debris it. I stayed overnight, they gave me some antibiotics through an IV, and were changing my bandage. The next day they released me and I had a program where the nurse would come to my house three times a week to monitor the wound and change the bandage.
So, that was the plan. Then about 3 weeks later when I was in rehab getting therapy for my shoulder and when I was transferred, my knee broke with a hairline fracture. So, I now had the sore and on top of that my legs were elevated all day with a cast from about mid-January until late April.
Throughout the care that I received from the nurses that came to check on the sore, they constantly said it was getting smaller. So, we kept the routine. Then I went back to the hospital in late March because I thought I was getting a second sore. They said it didn't look like I was getting another one, but they recommended that since the sore wasn't healing that I see a surgeon about the wound.
In early April I went to see a surgeon, and he said that although the wound looks close to healing it is actually bigger inside than what it looks like, and that they were going to have to do surgery on it. He was more towards using a vac system or he said he would open it up and put stuff in there to heal it and then sew it close. He said if these two options failed, I would have to get a flap done. So, I was set for surgery in mid April.
The day before my surgery I went to go see a doctor I trusted a lot, just to get a second opinion. After looking at the wound he suggested that although the vac system would probably heal the wound, he said that the scar tissue would be weak and would just reopen again sooner or later. So, his recommendation was that I go see a plastic surgeon and get a flap done.
By this time the nurse had stopped coming because their prescription had run out, and we were going towards a surgery route anyways. *Also my parents could change the bandages better than them.
So, I went to see a plastic surgeon down at Thomas Jefferson University. His recommendation was that he would probably opt more towards a vac system rather than a flap, but first wanted to get an MRI of my pelvis to see if the bone was infected.
I got the MRI and when I went back to visit him, he said that the bone was infected, and would probably have to be removed. So, he told me to meet with an orthopedic surgeon, which I have an appointment to meet with him on the 29th. He works at the Rothman Institute. He said that because the bone is infected I would need to get the flap done and that an orthopedic surgeon needs to be in the operating room to deal with the bone.
I feel very fortunate because had I not gotten that second opinion and canceled my surgery and then saw the plastic surgeon, I would have never of known that my bone was infected; however, he told me about the consequences of the surgery if the bone is removed.
After the surgery I would be in bed for about a month on a clinitron sand bed, then from there I would go to a rehab facility. If the bone is removed I would then be sitting lower on my right side where the infection is then I would be on my left, and therefore my left side will now be prone to a pressure sore.
I'll know more about whether or not the bone can be saved after I meet with the orthopedic surgeon.
What I do want to know though is if anybody has had these problems and surgeries. I want to know if I am going in the right direction. I'm extremely nervous about this operation because I know that Christopher Reeve died from a pressure sore that got infected.
I don't know how I got this sore because I do so much physical activity weekly like the standing machine, weightlifting, pressurized boots, and am constantly being moved around. I'll never understand it!
If anybody can help me with any information, it will be greatly appreciated.
Well, did you sit on an open wound?? Sounds like it.... Thats how it got bigger.
The original could have b3en caused by anything... scrap from transfer, cushion to hard... bad position...
A wound will not heal with an infection, so thats priortity 1.
For the record you'll be in bed for a while longer than 1 month... It's been 2 1/2 yrs with mine, VAC but no surgury.
Probably not your intention, but this comes off a bit incompassionate.
Originally Posted by Patonb
I echo your thoughts to him; good luck in healing those wounds.
Paton is right though.
Have they thought about a course (like 13 weeks) of IV antibiotic and oral antibiotic therapy? I had osteomyelitis in both feet - fifth meta-whatever-it-is and the heel ... I was on a PICC line IV receiving antibiotics (and working no less! but not for the first 3 months). I was also taking like 500mg of Cipro twice a day.
My last bone scan showed no sign of osteomyelitis (I should have had another done but I haven't).
Have you consulted with an infection specialist? I'd implore you to seek an aggressive one before you fool around with a pelvic bone.
well... with regards to your statement asking if I sit on my sore. Yes. Usually around 12 hours a day. I really don't have any choice but to, because it is just me and my mother all day, and the only way I get into my chair is when my brother leaves for work in the morning, and when he comes home at night. And on the nights when my mom is working, my dad comes over when he gets home from work.
If I don't get in my chair in the morning, I won't be able to get in the chair at all, and when all this happened I was in the middle of a semester at college, and I didn't want to drop out of the semester.
With regards to an infection specialist. No, I have not seen one. I'm more towards waiting to see what happens with my appointment from the orthopedic surgeon.
It's been five months, and I really think I need to get this addressed ASAP. I feel like all I do is keep seeing doctors without getting any progress done.
On a side note... if I do have to lay in a sand bed for several months, how will I be able to do the bowel program? Does anybody know?.
Thanks for the posts so far
Absolutely! You must immediately get the ball rolling. Your life is at stake here. If you are running a fever, or have chills go immediately to the ER and ask for an infection specialist.
Originally Posted by Dann21
I dealt with this problem 20 years ago and ended up having a lot of bone removed in order to heal. After watching others deal with this over the years, I recommend bone removal from the git go. Two many flaps fail because of infected bone that should have been removed.
It sounds like you are on the right track now. Unfortunately you are paying for your decision to sit on the wound anyway, instead of the bedrest that you should have had.
When you see the orthpedic surgeon, discuss the infectious disease consultation with them. What we do, when osteomyelitis is discovered, is to do a 6-8 week course of IV antibiotic therapy (based on the bone biopsy done by the orthopedic surgeon), then debride the wound and bone, then do a myocutaneous flap (the orthopedist and plastic surgeon do this together).
We do at least 5 weeks on the Clinitron of total bedrest (if everything goes well), then a LAL mattress for another 3 months minimum. We do your bowel program on your side on the Clinitron that entire time (we do not allow commode until the end of the sitting program). We also don't allow you to do your own bowel program, even in bed, until the staples/sutures are out, as it is too easy to disrupt and/or contaminate the suture line (which will be quite near the rectum). This is usually at least 4 weeks post-op. Some people even need a temporary colostomy while they are recovering from a flap.
We usually start the sitting program at 6 weeks if everything went smoothly. The sitting program takes at least 3 weeks to go from 15 minutes/day to 4 hours twice daily.
If you have to have the entire ischium (or most of it) resected, then you will need a custom seating system before you start the sitting program post-op (which should not start for 6 weeks after surgery). Otherwise you are at very high risk to break down on the other side.
The whole course of treatment you are looking at is 5-6 months. This means you probably should plan to take the fall (and of course, the summer) off from school.
I PMed you, Dann...
No advice, but a ton of moral support...
Take care, mend well...God bless!
Thank you very much SCI-NURSE for your information.
Everything you said so far seems to be all the information I was given about where I'm probably going to have to go from now, except for the info about going on an IV antibiotic therapy for 6-8 weeks, but that might be information I get from the orthopedic surgeon I meet with on the 29th.
I do have a question about the antibiotic therapy. Well I have to stay in the hospital for that? Or is that something that can be done at home?
Also, what is the antibiotic therapy for? Is it to save the bone?
Once again... thank you for all the information.
Tena, thanks for your support as well.
Hi Dann. Sorry to hear about your sore. I hope it heals up soon. I am a somewhat similar situation as you, although it is my foot that has the sore on it. I was put on both oral and IV antibiotics for 6 weeks. A PIC line was put in my arm and I have been recieving the antibiotic therapy at home since then. In my case it was done to clean up the infection in the bone before surgery, which I am having next week. And also to try and heal things a bit better to give the surgery a better chance of succeeding. I know every case is different but that has been my experience and maybe helps answer your questions a bit. The PIC line and IV has been an annoyance but it is managable and it was a much better alternative than staying in the hospital. Take care.
Originally Posted by Dann21