Out of the frying pan and into the fire

Or as Bilbo put it, escaping goblins to be caught by wolves.  After pretty much recovering from the meningitis and its psychological sequels, I stepped on a minute piece of glass in my kitchen.  Although I had bled a bit, my wife Gale got the glass out, and I went to the podiatrist to be fixed up.  The lesion was only 5 mm x 5 mm and 1 mm deep and looked fairly trivial.  But within three days, I had massive cellulitis (bacterial infection of the skin) in the foot and lower leg.  Foot trouble for diabetics is far worse than foot trouble for anyone else, and hey presto, I was back in the hospital being looked after by three separate teams of doctors: podiatry, infectious diseases, and family medicine (one of the analogues of general practice in the U.S.)

Heavy-duty antibiotics relieved the pain in the leg (I feel no pain, touch, or temperature sensations in my feet, though I do feel pressure) within a few days, but the external signs were still very ugly.  So my podiatrist decided to cut me open at the worst-looking spot, basically chopping from the top of my foot down almost to the sole.  Fortunately, I've had no pain from this.  More antibiotics and having my foot squeezed to get the pus out was pretty successful, and I was sent home after two weeks: a very different story from two days, but at least my mind wasn't affected this time.  Of course, I'd gone from an infected foot to a wounded one (the trivial cut on my sole had healed already), though at least the wound was clean and straight.

So I've been back at home for the last two weeks with a permanent IV line installed and a less comprehensive antibiotic, after I was found to have non-MRSA staph.  The surgical wound is healing better than expected: fortunately, my gross circulation is fairly unimpaired (you can feel strong pulses in my feet), so it's quite likely that I'll come out the other side essentially as well off as before. (I have two permanently broken toes on that foot, but the don't impair my walking.)  Meanwhile, I'm working from home and attending meetings by Skype, but only at 85% of full time thanks to all the doctors I have to visit repeatedly.  I'm walking on the heel of the bad foot using a surgical shoe (a sort of sandal with a very stiff sole) plus a crutch on the good side, and hopefully will be upgraded to something less restrictive after tomorrow.  Again hopefully, the IV will be terminated after Wednesday.

Oddly, no connection was ever found between the glass cut on my sole and all the pus in my foot, so just how the staph got into my foot remains completely unexplained.  Gale, who is not diabetic, had had cellulitis a month before, but she had a visible scratch on her leg, and two days in the hospital on IV fixed her right up.  Also, the cold I mentioned turned out to be an allergy, which nose drops are slowly clearing.  Nothing has been done about the low hemoglobin yet, and I also will have to see a vascular surgeon when I can walk again.


Getting sick and getting better

This post is mostly meant to account for what has happened to me since August 23, with some explanation of the things I have posted on the Internet lately.  It will be of interest, if at all, to (a) people interested in me and my physical, mental, and emotional state; (b) people interested in certain medical matters which I exemplify; (c) people who are puzzled by my recent lack of postings followed by rather oddball postings and private emails (or remarks, if you know me in person).

I will mostly state what happened to me in the order it happened.

On August 23, I left work very ill, and arrived home shortly thereafter, where I was found to have a fever.  I took acetaminophen to try to reduce the fever, and rested.  On August 25, I went to an internist and received a diagnosis of strep throat (although my throat did not hurt) based on a quick strep test.  I was then given a large penicillin injection to kill the strep organism, though I was told it would not much shorten the course of my disease.  I was advised to rest and drink fluids so
that I would not become dehydrated from the fever.

Unfortunately, there were two mistakes here.  One was that the positive result on the test was false, and therefore the penicillin was useless though harmless.  The other was that because I had undergone roux-en-Y surgery in December 2012, it was impossible for me to drink sufficient fluids sufficiently quickly to avoid dehydration.  Over the period from at least August 23 on, therefore, I was suffering from an unknown illness, which turned out to be two illnesses: viral meningitis, and an upper-respiratory viral infection in the nature of a cold.  I was also, as a result of the fever, suffering from progressive but unsuspected dehydration.

On October 1, I went to another internist; due to a change in my insurance between August 25 and October 1, my first internist could not see me unless I paid him cash in full on the spot.  This second internist ran further tests establishing that I did not have the flu, or pneumonia, or any of a variety of other diseases, but could find no specific disease.  I was again sent home and told to rest (which I did) and drink additional fluids (which I did not and could not).  The cold was evident at this point, but did not account for the fever; the meningitis was as yet unsuspected.

Unfortunately, of the two fever-reducing drugs I was told to take, one (acetaminophen) was effective but easy to overdose on, so I could only take it in limited amounts.  Either for that reason, or because of the natural course of the meningitis, I was feverish on some days but not other days.  The other drug (ibuprofen) was also effective, but had the bad side effect of causing me to shiver.  In order to stop shivering, I had to add outside warmth (a blanket was insufficient), which would revive the fever.  When I finally noticed this pattern, I stopped taking ibuprofen, but continued to take acetaminophen.

The ongoing and untreated dehydration had several side effects.  For one thing, my blood sugar (I am a diabetic) went some 200 points above my previous worst-case reading, which was itself some 200 points above non-diabetic normal.  Another was that I urinated less than usual, and with darker urine.  Yet another was that I found it hard to draw blood for blood-sugar tests.  My thinking function became disordered, not only when I was feverish (a familiar phenomenon enough) but also when I was not feverish.  As a result I began to fear that even if I recovered from whatever I had (besides the cold), my thinking would remain disordered, and I would be unable to work thereafter.  (I did not fear absolute starvation for myself and my family, but I know too well how difficult the life of a partly mentally disabled person in the United States is.)  Lastly, I began to stop producing normal tears, so that my eyes partly dried out.

Due to the dry eyes and the high blood sugar, I decided to go to the emergency room on October 5th.  I was admitted to the hospital (something I do not remember) and was put on IV fluids and a Foley catheter (a device which causes urine to flow out of my bladder through my urethra into a bag without volition on my part).  I was also found to have a bacterial infection in my blood and my kidneys, for which I was put on antibiotics.

Investigation of the blood work done on the 25th but never yet looked at revealed that I had never had strep throat.  I was given a lumbar puncture in the hospital, which finally diagnosed the viral meningitis that I had had since the 23rd.  This was now passing off, as the virus was no longer active (nor would there have been any treatment other than supportive treatment if it had been).

On October 7th, the hospital concluded that I no longer needed fluids and removed the fluid bags from my arms.  On the same day, I demanded that the hospital remove the IV taps (under the specious claim that they hurt me), and later that day signed myself out of the hospital against medical advice, as I could see that the hospital had nothing to offer me medically, and was only trying to keep me in a bed out of an abundance of caution.

I wanted to leave because, as is often the case in hospitals, I had had very bad nights there, being unable to sleep well.  Furthermore, I had a roommate who was dying of terminal cancer and kept insisting that the hospital release him; sometimes he lost his grip and believed instead that he was no longer in the hospital but in a police precinct, a Chinese restaurant, or some other presumably non-existent location. The fact that during one period there were in fact police in his room, apparently to protect the hospital staff from his aggressiveness, no doubt tended to confirm this particular delusion.  Although I was recovering from the meningitis and dehydration that had disordered my thinking, being exposed to all this nonsense was also disordering it, leading me to conclude that it was outright mentally harmful (and not physically beneficial) for me to be in the hospital.

Indeed, I had come to believe that if I died in the hospital (as seemed likely in my disordered state of thinking, though objectively it was not) that I would be dying in Hell, something I desperately wanted to avoid.  The impersonal treatment I received seemed to underscore this.  So I came home, still suffering from the same cold, but free of meningitis and fever, and cured of my blood and kidney infections as well as my dehydration.  Once I had a good night's sleep at home, many of my mental issues were relieved.

I went to a third internist on October 9th, who had access to my hospital records and in fact had been the one who had admitted me to the hospital: he told me several more diseases I did not have (though two remained, and as far as I know still remain, possible; though they had not grown out on a bacterial culture, they might still do so).  By his advice, I spent the next few days recovering from both my sickness and my bad hospital experiences, began to work (without going to the office) on October 12, and went to the office for the first time October 13 and for the second time on October 14.  I had gone to the office, unwisely, on another day (I forget which one) sometime early in October, but got little done that day.  On October 19 I will be seeing yet a fourth doctor, an infectious-disease specialist who saw me briefly in the hospital.

The upshot is that while my thinking is no longer (I believe) disordered in general, I still suffer from the fear that it may be disordered in particular instances.  Therefore I have been asking questions whose answers may seem obvious, and making remarks whose truth surely is obvious, to outside observers.  I am doing this not to be funny, nor to be ironic (to pretend to know less than I know) but to reassure myself that I am in fact understanding correctly and reasoning correctly.  Since my confidence in my thinking (as opposed to my thinking itself) may take some time to restore, this may continue for some time.

I hope I have been sufficiently clear in writing this.  I am entirely open to answering any questions, in the comments or privately, about any part of my experiences.

Update:  It turns out the blood poisoning and kidney infection were not confirmed by the lab test, so things weren't quite as bad as they were thought to be.  My mind continues to clear.  However, my hemoglobin is only about 60% of what it should be (probably accounting for my continuing fatigue), so here beginneth a new round of doctor visits and lab tests.