Day 24 // Another Step Completed (and some context)

JoAnne's procedure went well today! See below for the details, as well as some back-story about her infection and how it pertains to her recovery.

ABDOMEN - Dr. Ramzy closed up JoAnne's abdomen wound today! This is great news, as this means he felt that the muscle fascia was ready to begin the healing process. An open wound of that sort for too long can also be a risk to her organs, random infections, etc., so that's another reason this is encouraging news. As you know, they hadn't wanted to close her up too soon for fear of also enclosing any lingering infection. That is not to say that there is no possible bacteria left, but after many intensive wound cleanings, Dr. Ramzy has come up with nothing, so he's had to make the call that healing is the next step. She'll be under a paralytic drug again until tomorrow so that she's ensured total rest to her abdomen... we'll keep you posted on how she's doing tomorrow as she wakes up a bit.

HIP - Dr. Madey did not work on JoAnne's hip today, but plans to see her Monday. The aim is to remove the packing that has been providing antibiotics (some type of sulfa drug) and insert a shunt for more fixed, consistent draining. Not to be too detailed, but you may wonder why there is so much draining going on! They explained to us that there is bleeding because there is healthy muscle that has been brought together from the amputation and reconfiguration surgery. Bleeding technically is a good thing, as it means the muscle is healthy... but the healing process always takes a bit of time, and the bleeding puts her at risk for infection. The fact that they're not as worried about packing her wound with the antibiotics seemed encouraging to us, as the shunt may be the next logical step in her healing process? More on that as we learn about it Monday.

INFECTION CONTEXT-  I'm sure we seem to constantly mention JoAnne's risk for infection. I guess it may seem a bit odd at this point in her recovery, as her WBC (her immune system marker) has leveled out magnificently over the last few weeks (it's neither high nor low), and the surgeons have been very certain they've done all they can to clean out her wound sites. Yet, there is always the risk of further infection. Her most recent abdominal debacle was a common infection from her colon surgery, but still could have been life-threatening. On top of that, we learned a few days ago that the original bacteria she had is not only dangerous because of the devastating effects it can create in such a short period of time, but also because small particles can lay dormant, waiting to spring again if her immunity dips low enough to allow it to spread.

This is clearly a very disconcerting piece of news. We asked the doctor how on earth they can know if the bacteria ever starts up again, igniting another terrible spread of infection. He said that she will have to be constantly monitoring this, and a healthy WBC (white blood cell count) is paramount in preventing any bacteria from acting, should it re-ignite. But they did say that she will always be at risk. Granted, JoAnne could live her whole life with no other outbreak, or could find herself back in the hospital in ten years. It's hard to say (and even harder for us to accept!). Again, we've got to stay in the present, but prepare ourselves as needed for the future. 

If you'd ever like to learn more about the bacteria in question, it's called clostridium (a type of necrotizing fasciitis- beware of graphic photos if you google search this). I learned that it was closely associated with gangrenous infections in Vietnam, and that although it can be present in as many as 90% of infections, will only spread or become affective in under 2% of cases. This is a very rare bacteria, though well-known in the medical world. Everyone in the ICU knows about JoAnne's case, and they are so incredibly impressed that she's done so well, for so long. Although it's terrible to feel so at mercy to this bacteria, it's also heartening to realize what a strong, healthy person JoAnne is and has been through all of this. HOPE!

I hope this wasn't too much information, guys. We just want to make sure we're all on the same page with the risks associated with JoAnne's recovery. We love you all so very much, and so appreciate your support and sweet comments here on the blog...

More tomorrow,

Team JoJo