Wound Chronicle in 9 Acts
The cancer should have been the biggest challenge, being stage 4 metastatic melanoma after all. And I won’t deny that the initial diagnosis and surgeries in 2022 rocked my world. Even as the side effects to the melanoma treatment started to pile up—malfunctioning thyroid, intense fatigue, nausea—I was confident that as long as I would be granted a reprieve from the cancer, that I would overcome the side effects and get back to my life.
This mindset worked for a while…until the colitis and then the leg infection hit in 2023. The weeks of dealing with these complications turned into months and then years.
My conditions are being contained in a first in, first out process. Contained, because it seems that very few serious health conditions are ever 100% resolved.
The first diagnosis—melanoma—is tamed for now. Several CT scans over the past 9 months show that the cancer is in remission, and I’m not undergoing treatment for that disease. I am signed up for CT scans for the rest of my life. See:
The second diagnosis—ulcerative colitis—has been a rocky road. Although Chris still needs to administer (via subcutaneous injection) a fancy biologic every 28 days, the disease itself has receded. Maybe maybe? I can stop taking the med some time in my future.
This post is about the third condition—an aggressive bacterial skin infection—and the long, torturous route my leg has taken on its path to healing.
Act 1. Immunotherapy
This Act might be called Act 0 because the wound was just a glimmer in the universe’s eye when I began immunotherapy treatment for melanoma in June 2022.
The immunotherapy instructed my immune system to attack errant, suspicious cells, including apparently cells in my colon. The ensuing inflammation caused all sorts of unsavory side effects and a diagnosis of ulcerative colitis in May 2023.
Act 2. Prednisone
Prednisone is the first standard treatment for colitis. The drug suppresses the body’s immune system to slow inflammation. Suppressing the immune system in my case predisposed me to severe infection.
After dutifully swallowing milligram upon milligram—with no relief of the colitis symptoms—I developed a raging bacterial leg infection on July 9, 2023. I’ll never forget that day and the speed in which the pseudomonas bacteria conquered my lower right leg. I underwent surgery that afternoon to check how deep the incursion was. While it looked like a flesh-eating bacteria, fortunately for my limb and important internal organs, the damage was limited to the dermis. However, the wound was so large and deep that once the dead tissue was removed a few months later, we could see a tendon running through the wound cavity.
Another striking memory of that Sunday was my oncologist standing at my bedside in the ICU, looking on in shock at my pathetic self. None of this was supposed to happen.
Act 3. Rehab
I spent a month in the hospital. The large leg wound had a very large impact on my mobility. After losing all my lower body strength, I spent time in rehab gradually learning how to walk again. Complicating my recovery was the ongoing colitis and my weight—100 pounds (45kg).
Some of my thoughts about that intense experience are here:
Act 4. Wound Vac and Debriding
While in the rehab hospital I underwent another surgery in late July to remove the sutures from the first surgery and debride the wound. The surgeon also attached my very first wound vac. Special! Little did I know that I would spend two and a half months with the vac attached to my leg. When I returned home, we trekked to the wound clinic three times a week to have the dressing changed.
I also would never have imagined that I would spend countless hours lying on a table while the wound doctor scraped away at the large wound to will the tissue back to life. Its size at the outset was 22x14cm (8.5x.5.5in) and wrapped around the back side of my right calf. I guess it’s a blessing that I wasn’t able to easily see the wound as the saga unfolded. Some months after I was home, I compiled photos of the wound and was astounded that they depicted my body. Unreal and other worldly are adjectives that describe that leg. I included a link to photos from July to late October 2023 at the end of this post:
The synergy of the wound vac and debriding achieved good results: granulated tissue and a reduced wound size (around 10x8cm).
In late 2023 the wound was in good condition to receive a skin graft. I, however, was not. The colitis was still a large liability that left me exhausted and severely underweight. I had not found a colitis treatment that worked and so was uneasy with the prospect of opening up another wound to be a donor for the graft. Plus, skin grafts can fail and my leg wound started from an infection, not the best starting position to host new tissue. I decided to forgo a graft.
Act 5. Multi-Approach Approach
This is also known as throw things against the wall to see if anything sticks.
Somewhere in early 2024 all progress stalled. The wound bed was covered with fibrotic tissue, which impeded my body’s ability to grow epithelial cells at the perimeter. We tried multiple debridement treatments. For kicks, we also threw in hyperbaric oxygen therapy, a treatment to support my body’s ability to heal. Lots of promises made, none kept. To be clear, the literature, not my doctor, proudly made the promises. I have profound respect for my wound care doc in his persistence and creativity in dealing with my case.
Honey
MEDIHONEY® Antibacterial Medical Honey™ stands as a revolutionary topical solution, harnessing the potent antibacterial properties of 100% Antibacterial Leptospermum (Manuka) Honey™ for comprehensive wound care. This remarkable product is designed to address both chronic and acute wounds, offering clinically proven effectiveness in various scenarios.
Hydrophilic wound dressing
Hydrophilic paste for light-to- moderate levels of wound exudate. Helps maintain a moist wound healing environment to facilitate autolytic debridement. Ideal alternative for difficult-to-dress areas and varying wound etiologies.
Bleach
Dakins sounds cool with these key benefits!
Broad-spectrum antimicrobial
Effective against viruses, bacteria, fungi, yeasts, and molds—including resistant strains such as MRSA and VRE
Proven to be safe and cost-effective
Non-irritating, non-sensitizing
No antibiotics, no alcohol, no steroids, no-rinse formula
Two-year shelf life
Hyperbaric oxygen therapy (HBOT)
HBOT “increases delivery of oxygen to the body by providing pure oxygen in an enclosed space with higher than normal air pressure.“ The goal of using HBOT for wound therapy is to enhance the body’s ability to grow new tissue.
Look at me getting ready to enter the chamber!
I endured these two-hour long daily sessions for 27 consecutive weekdays. Fortunately, I caught up on some important movie re-watching, because unfortunately, the treatment didn’t affect the wound. For posterity, this is what I watched:
Before Sunset, The Reader, Presumed Innocent (the movie), The King’s Speech, Friday Night Lights (the movie), Capote, Mr. Roberts, Juno, Big Fish, The Goodbye Girl, Elizabeth, Road to Perdition, Gran Torino, Little Miss Sunshine, Cool Hand Luke, One Flew Over the Cuckoo’s Nest, Awakenings, The Last King of Scotland, On Golden Pond, Blue Valentine, The Bridges of Madison County, Pitch Perfect, Pride and Prejudice (from 2005 with Keira Knightley), The Horse Whisperer, The Shawshank Redemption, The Fog of War.
Antimicrobial glass
I may not be diabetic, but this article about antimicrobial glass shows a lot of promise for wound healing!
…the addition of BG (bioactive glass) is extremely valuable with regard to the wound healing rate and wound healing quality, since BG activates fibroblasts, enhances M1-to-M2 phenotype switching, induces angiogenesis, and initiates the formation of granulation tissue and re-epithelization of the wound.
Act 6. A Detour into Darkness
In March 2024 I experienced intense knee pain that just so happened to be on my right leg, the leg with the wound I had been trying to heal for eight months. Multiple X-rays and an MRI later, I learned that I had suffered from avascular necrosis, death of the bone marrow. One of the doctors I visited was especially dour in alerting me to the likelihood that all of my joints would eventually succumb and that I best secure a walker. My joints could start to fail any day.
After sobbing in the car after the appointment, I tossed this doctor in to the Worst Bedside Manner bucket and tried to move on. Some weeks later I found a new doctor who essentially gave me the same diagnosis—dead marrow—but also encouraged me to strengthen my muscles around my joints and live my life. My joints could start collapsing in a few months or a few years. I would know when to take action but that day was not today. It was then that I decided I needed to up my walking regimen. Walking is helping to build strength and calm my colon and make me happier, as I describe in the following article:
Cautionary note: Prednisone is implicated in my joint issues.
Act 7. Biopsy
One day last fall, my wound care doctor asked me if I’d like to have the wound biopsied. Sounds great, I said, enthusiastically and sarcastically. I really did want to know what was impeding the healing process, and if a biopsy would answer that question, I was happy to handle the pain.
After administering lidocaine to the biopsy sites, he took two punch biopsies. Preparing the biopsy sites with the anesthetic was the painful part of the procedure.
The results were encouraging—I wasn’t suffering from a bacterial infection or cancer—and also maddening—my body was unable to transport waste out of my lower leg. This is one of my favorite medical readouts because I don’t understand a thing without looking up nearly every word.
The sections show two punch biopsies of benign skin showing acanthosis with overlying hyperkeratosis. There is a proliferation of superficial dermal vessels with associated chronic inflammation. There is underlying dermal fibrosis.
The histologic changes are those of marked stasis changes with overlapping acroangiodermatitis and underlying extensive dermal sclerotic fibrosis. These changes are likely due to severe chronic venous stasis. The histology does not support a diagnosis of pyoderma gangrenosum.
Based on these results, the doctor added four-layer compression to my treatment plan. My leg was now encased foot to knee in four layers of various materials.
Act 8. Mini Graft
We next tested grafting a small portion of skin from my thigh to an area of the wound near the perimeter. Wound care visits became exciting again—what would the unveiling reveal? After two weeks, it was clear that the graft was contentedly growing in its new location! This meant that I could more confidently schedule a full graft. Which I did, stat.
Act 9. Big Graft
My big day was January 23, 2025. Surgery prep included a lot of laundry the day before and sterilizing my entire body with chlorhexidine gluconate, sold as Hibiclens. Once under anesthesia, the surgeon debrided the wound, removed donor skin from my thigh—8x4.5cm (3.5x2in)—and stretched it over the debrided wound.
The surgery was uneventful and I was back home that afternoon with a cute little wound vac attached to my lower leg.
Everything seemed fine until the bleeding started up and the wound vac that was supposed to last for seven days filled up before I went to bed. No way to change a canister as with my other wound vac. Eek. Plus, the alarm kept on telling me what I already knew: the canister was full. Do we go to the ER or wait it out? We somehow made it through the night.
The next day I visited my regular wound care doctor, who worked hard to stop the bleeding without disturbing the graft. I had never seen him so serious in our year-and-a-half relationship. He was successful and then packaged up the leg, complete with a half cast so that I would not disturb the relocated skin.
Another new-for-me intervention is using crutches to avoid putting weight on the leg and disturbing the graft. Between the pain of the wounds and the annoyance of not being able to carry a dish from the kitchen to the dining room table, I have felt like I have gone backwards. Thank goodness my upper arms are getting a tremendous workout.
Each doctor visit continues to be exciting as we wait to see how the rehomed skin is doing. The latest visit showed a happy graft. The donor site on my thigh is also healthy, healing.
For such a long time I didn’t let myself ponder taking a bath or walking around without a curlex gauze dressing and tubigrip elastic bandage on my leg. Now I see a small point of light through that leg wound tunnel.
Animal Coda
Here are Bear and her pal Daisy playing chase.
Everything Betty Littrell said so eloquently, plus this: What struck me in your nine acts and inserted stories was the dozens of medical terms and pharmaceutical names you’ve mastered as part of your everyday life. That speaks volumes about what you’ve endured. Nobody outside medical specialties wants to know all that; my heart is filled with compassion and my eyes with tears that it’s all in your vocabulary.
You are a teal trooper! I’m so sorry for all you have been through but you are a true inspiration to me.