Warning:
Gross pictures ahead!
Here are what her feet looked like on
Friday, June 24. The night before was the end of her week and when
she woke up the next morning, her feet were swollen and red, almost as
swollen and red as this picture here. I would say this was probably
around 4-5 days after the first indication of a "rash", what we know
now to be an infection.
These pictures were taken after
we went to the emergency room at Mariner's Hospital and learned that it
wasn't
an allergic reaction but rather an infection. The sores on both ankles
and toes were typical. For at least a week or two she'd come home with
sores like this that all started from blisters and friction with
saltwater and sand
underneath her Teva straps. Everyone at her workplace suffers
from them. I tried again and again to get her to use
booties or socks or something to prevent the blisters. I wasn't
thinking about preventing infection, but rather just avoiding
unpleasant blisters (the kind you get from hiking). Myra kept
wearing the Tevas until her feet started looking even more cut up and
that's when she wore some "waterproof" socks that were given to her by
her mom. Whatever, they were just
cotton socks. Everyone at her workplace gave her wierd
looks. What I and her mother hadn't thought of when we
urged her to wear socks is that they would end up keeping her feet wet
all day and this probably increased her chances of infection. She wore
the "waterproof" cotton socks on Wed (June 22) and some of her own
caperline socks on Thurs (June 23).
This next one wasn't a good picture,
but it illustrates how swollen her ankle was; the skin was creasing
into rolls.
=====================================================================
This is now Sat, June 25 around 10am.
I had just applied the Bacitracin to her feet for the first time, the
stuff given to us by Mariner's Hospital the night before. She had
told them that she was allergic to Neosporin and Polysporin, and so
they had recommended Bacitracin instead. We put this on the small
sores around her ankle and big toe. We also applied it to
the rash-like blisters on her feet. Myra was also prescribed
Keflex antibiotics by Mariner's. She had taken 3 Keflex tablets
at this point. Her feet
were very itchy and when I applied the Bacitracin, Myra loved it
because I was rubbing the itch.
Only an hour or so after this, the
itching and burning continued and increased. That's when she started
worrying that she
might be allergic to the Bacitracin and so I washed her feet and let
them dry and never used the bacitracin again. During the washing I
noticed the sore near her achilles was very painful and oozing
small amounts of goo.
Saturday evening:
==========================================================================
Sunday morning June 26. Myra was
getting ready to go to work at Theater of the Sea. The swelling
in her foot had gone down. Mariner's Hospital had not given her
any care instructions at all and did not protest when Myra asked them
if she
should still go to work in 2 days. Even though they hadn't given
her any instructions, Myra decided to at least stay out
of all water.
Myra left for work at 8:30am and came
home around 2:30pm because her supervisor told her to go home and
rest. The swelling and pain had increased, and even before being
dismissed Myra had already told them that she wouldn't be coming to
work the next day.
This is what her foot looked like after she came home from work:
Her feet looked really bad at the time
(it's hard to see in the bad light) although looking at it now they
really weren't all that swollen compared to 8:30a, but nearly
every blister on her foot had broken open and looked really nasty, so I
opened the blinds and zoomed in for dramatic effect.
Myra was pretty worried about her feet
at this point so she got on the internet and looked up which hospital
was the best in Miami. She found out that Baptist Hospital was
not only the best in Miami but also one of the best in the entire
state. Although I felt that she hadn't given the Keflex enough
time to work, she finally convinced me to drive her the 2 hours up to
Baptist, and we got
there a little before 6pm. They were very concerned and immediately
rushed her into triage. Within 15 minutes, they had sampled all
possible bodily fluids and she was
hooked up to an IV of tequin. Because of how busy the E.R. was,
she sat alone in the hallway for about 3 hours. At midnight, they
took x-rays. At 3am we finally got to meet with a physicians
assistant. He was upset that Mariner's Hospital hadn't even given her a
tetinus shot. He also felt that on top of the infection, she
still had an allergic rash from the Bacitracin they had given us
(apparently Bacitracin contains the same basic ingredient as Neosporin
and Polysporin. Mariner's should have known that). We were
told to throw away the useless Keflex and instead take Tequin which is
stronger.
We left around 5am the next
day after nearly 10 hours!
================================================================================
By the next day (the 27th) her feet
were
all bandages, Myra had been given her tetinus and was on Tequin tablets
and Atarax
for the itching. Baptist hospital gave instructions to stay off
her feet and keep them elevated.
Her right foot is still quite a bit
larger than her left. Her leg was hot a few inches above the
wrapping but she didn't have a fever.
====================================================================
We left the bandages on and didn't see
her feet again until our next visit to Baptist the evening of the 28th.
Since the antibiotics hadn't had time to fully work yet, I didn't feel
like we had to go back for a follow-up, but Myra finally convinced me
to drive her up there (she was threatening to take a taxi if I didn't
drive her). We finally got to meet with a full-fledged, real
doctor this time. The doctor in the minor treatment area
unwrapped her feet and was concerned about the blisters
until we told him the foot was noticeable less swollen. Then he relaxed
and told us to continue treatment. The nurse rewrapped both
feet and then we left. She had developed a very large blister on
the top of her foot
near her toes. It was about the size of a half dollar, clear, and
under more pressure. The side of her foot was chewed
up looking where she used to have the tiny rash-looking blisters, but I
didn't notice anything on the bottom of her foot. They told her
to continue staying off her feet and keep them elevated. I didn't
bring the camera because I didn't want it to be in the way.
====================================================================
Myra's foot:
When they unwrapped the gauze the big
blister on top jiggled like a blob of jello. It was icky. It's a little
smaller and darker then it was before (three days ago). Back then it
was clear and
pressurized (I didn't take a picture of it). The swelling is gone
around her ankle but her foot still looks a little puffy and red. Her
toes are swollen as well. The medical student who helped treat her on
the first day agreed that overall the swelling had gone down a
lot. As the swelling went down, she developed some other nasty
blisters on the side and bottom of her foot.
Here's a close-up of the blister on top:
The texture on top of the blister was just the result of the the guaze
wraps they had put over it.
Side of her foot:
There are two blisters there but only
the lower one is large and bloody and easy to see. A close-up of it:
None of the above blisters were
painful. The blisters on the bottom of her foot were the only
ones causing her pain:
When the doctor came half a second
later he said "We should culture those." And so he cut the thin layer
of skin off of each leaving the following slimy craters:
After the goo was cultured and the
wound wiped with gauze:
The side of her foot before being
cultured:
And after:
And finally the one on top of her foot:
They cultured each blister as they
opened it. We forgot to get one for the CDC. The med student applied
some Mupirocin ointment into each wound and covered the foot in gauze.
Nancy didn't think the blisters were all that bad.
The nurse instructed her to wash the wounds twice a day and keep her
feet dry. Before cutting open the blisters, they had promised
that it would relieve pain, but in fact cutting open the blisters
created a lot of pain for the next several days. They said she
could start taking Tylenol.
Her left foot is fine. Not worth
taking a picture of or even bandaging with gauze, although they did put
a bandaid over two of her scabs. Nevertheless that foot still
itches every now.
===================================================================
Over the next few days, her feet are in intense pain. The bottom of her foot is the least
painful. The cuts on the top and side of her foot are extremely
painful, especially when washing them. Because of the pain, I
didn't photograph them.
===================================================================
This what Myra's feet looked like as of July 5.
Myra thought her foot had reached a
normal size, but in my opinion, her right foot is still
a tiny bit swollen. We agree that her toes are
puffy.
The bottom of her foot is starting to heal:
The outer side of her heel is healing but
is still very painful:
The top of her foot no longer hurts as much:
Myra called Baptist to find out the
results
of the culture and they said they weren't able to grow anything. We
left a voice mail with Nancy asking her to double check since that's an
odd result. But then Nancy suspected it might be something weird that
requires a special growing medium. Who knows?
Nancy had been convinced this was the
result
of a staph infection given the blood coagulation visible when the
blisters were first opened (I guess). But then she said that if
it was a staph infection, they would have been easy to culture.
Perhaps the bacteria was already
dead since they waited an entire week before culturing? Perhaps
the antibiotics had permeated her blisters and had killed
all the resident bacteria, thus there was nothing left to culture?
There doesn't appear to be any
blisters left on her foot. There might be one tiny one left but
it's not confirmed. It appears to be visible in one of
my photos, but it hasn't grown any in size since the last few days:
The skin is very tough and leathery in
places, I assume because it has died. Her big toe feels tingly (pins
and needles) when she presses on
it. It basically feels like it's asleep (only when she applies pressure
to it), but she can move it without any problems.
===================================================================
The leathery dead skin has started to slough off. The new skin
underneath is very sensitive but healthy. She has started walking
on her foot again. Walking on it causes pins and needles type
pain and a few intense spasms of pain. When she stands there is a
dull pain in the pad of her foot and the arch (not where the blister
was). But she is able to walk around pretty well. The first
day that she started walking again, her foot swelled back up in size to
what it was when infected and turned red and itchy. That scared
us a little. Has the infection come back? The redness
disappeared again a day later, but it's still painful for her to walk
on it. We had an appointment with a podiatrist on Wednesday, but
after driving all the way up to Miami, we weren't able to meet with him
due to communication problems with Worker's Comp.
