Staying close to home

I've been hiding something in the posts we've been doing here since last week. On Monday evening, I made a vague comment about the fact we've been dealing with some "unexpected things," and said "tomorrow we'll do a longer post about what's been going on." This is that post.

After my new knee being rock-solid this summer and allowing me to get out and enjoy life on my own terms, last Thursday morning I started feeling some knee pain and stiffness. It rapidly grew worse, and by sunrise on Friday I was in the Emergency Room at St. James Medical Center.

It's a recurrence of the staphylococcus aureus infection that I experienced last fall, which led to an emergency cleanout surgery, eight days in the hospital, and months of painful recovery time. I wrote up that that experience last year in a blog post entitled Struck by lightning, and a few minutes ago, I published a post about the current situation, Struck by lightning twice. I've once again been very unlucky. Dr. Pullman had warned me of this remote possibility last year, and here we are.

The details of my situation, and the details of the treatment issues and options, are all covered in those blog posts, so I won't be going over all of that here, but here's a brief explanation of the most likely outcomes:

• Best-case scenario: the dalbavancin infusions (which I started yesterday), in combination with rifampin (which I'll start today) will kill all of the bacteria. If that works, with some PT and exercise I'd probably be back to normal in a few weeks. Dr. Pullman feel this is the most likely scenario, but anything's possible.
• Worst-case scenario: if the dalbavancin/rifampin treatment doesn't get the job done, I'll need surgery to clear things up. There are two surgical approaches used for this situation: DAIR (Debridement, Antibiotics, and Implant Retention) or two-stage revision. I had the DAIR surgery last year, so if there's still a problem after the infusion therapy, we'll be doing a two-stage revision this time. It's a much more invasive procedure than DAIR, and recovery is typically a full year or more, but if that's what we need to do then we'll do it. (If you want to know more, I wrote about the details of the DAIR and two-stage revision approaches last year here.)

I already wrote everything up on the Struck by lightning twice blog post today, but I'm posting here as well to make sure everyone knows why we've suddenly stopped posting photos and videos of hikes or long walks. The dog are rolling with the change well, as I knew they would, and when Megan gets home this weekend she's looking forward to getting them back out for activities I'm not ready for right now.

The pain of this infection has been quite intense at times, and consequently our "walks" have been just short trips out the door so that Nancy can find some nearby grass to pee on. The last time we took a vigorous walk all the way around the block was on the morning of last Thursday 9/10. Below is a visual summary of our morning and evening walks over the last week.

On the morning of Thursday 9/10, I was feeling strong and healthy but my knee was a little stiff. So we took a quicker walk than usual, because that's usually the fastest way to loosen up my knee if it feels stiff. I didn't take any photos of the dogs that morning, just that one photo of a house a block away that's shown above – I took that photo to show Megan that the neighbors were up watching Star Trek on their big-screen TV before 5AM. (I suspect they were staying up late, rather than getting up early.)

Since then, we haven't tried to walk more than 50 feet away from the house.

One thing I'm very glad for is that we've been getting in lots of walks and hikes this summer, and I've been working out hard. When this unexpected setback hit, I was feeling strong enough to deal with the first few days pretty well – my left leg hasn't complained at all about hauling me up and down the stairs on its own. You folks who follow this site known all about everything we've been doing: a pack outing to the Bitterroot Mountains, pack hikes at places like The Highlands, Humbug Spires Wilderness Area, The Continental Divide Trail, and Storm Lake, pack walks in the evening, my solo trips with Isaac and Nancy, and so much more.

When I met with the doctor on Monday this week to review test results, I knew that they'd ask how my knee has been doing this summer. So while I was sitting around Monday and not fit for much of anything else, I put together a 1-minute overview of how my summer went. It's mostly a compilation of clips you all have already seen, but if you'd like to see it you can find it over on the Struck by lightning twice blog post.

Overall, this has been quite a shock, and still feels a bit unreal. The pain, as well as the stress of various unknowns, is going to be an issue for at least another few weeks, best case. But the dogs and I are doing great, given the circumstances, and we'll be doing even better after Megan gets home on Saturday.

We've settled into a routine that's mostly about the dogs laying around while I'm icing my knee, and we're all coping the best we can. The dogs are being extremely energetic in their play time after meals lately, perhaps because of the lack of longer walks. I'll try to get a video of that to show you all.

That's our update on what's been going on! We'll keep you posted in the days ahead. The dalbavancin infusion is working wonders, so I'm cautiously optimistic that it will get me back to hiking and working out without the need for surgery. But if I need surgery, then that's what we'll do, and the pack and Megan will help me work through that. We still have lots of mountains to climb, and this is just a little rough spot on the trail.