What Lies Ahead

I just got back from doctors appointment in Mammoth. Yeah, the whole gang drove up there on Thursday for a Friday morning appointment with Doctor Michael Karch. And yes, we subsequently drove back to SB on Friday. Not really the most fun I’ve ever had on the Eastside, but oddly, Bridget, Mom, Dad and I had a pretty good time on our quicky of a road trip.

I don’t drive hundreds of miles through the dessert for just any doctors appointment. It takes a special doctor to motivate this sort of commute. I already knew that Dr. Karch was good at what he does. Afterall he did take a mangled leg, one that even he thought may need an immediate amputation, and put it back together so well that he sees a very full recovery in my future. But there’s more....

Scanning the waiting room prior to the appointment, one couldn’t help but notice the myriad of signed photos hanging from walls depicting skiers, snowboarders, kayakers, surfers and base jumpers. Alongside all of this there’s also a tattered racing number with a small certificate signifying that Michael Karch was a finisher of the Badwater Ultra Marathon. For those of you that don’t know already, Badwater may be the most grueling foot race on the planet. Starting at the low point of Death Valley runners travel 135 miles to the Mount Whitney Portal, along the way gaining around 8500 ft of altitude. I’m starting to think that Dr. Karch might understand the mind and body of an athlete. So I did a little research and found this article. For those of you too lazy to read the whole thing, skip ahead and read the last 2 paragraphs...... To paraphrase - Michael Karch isn’t fucking around.

Dr. Karch was pretty happy with how the leg looked. The wound from the most recent surgery is already healing up well. The wound-vac is a fascinating piece of machinery. By creating negative pressure in the area (like a continuos hickey inside a big hole in my leg) it fights off infection and promotes blood flow to area. The wound literally heals from the inside out in a clean protected environment. Once the internal tissue proves to be thriving and on its way to a nice recovery, I’ll be seeing the plastic surgeon. Another quick surgery will take a skin graft and cover the wound, essentially closing it off from any outside contaminants.

We then turned to the future. This is a waiting game by any standard. There’s two large hurdles standing between me and a jog in the park.

First off, the bones need to actually grow back together. Not only did I break the tibia and fibia into over 10 pieces, but trauma also sheared the outer sheath off of the bones. This outer sheath (sorry can’t remember the name) is responsible for most of bones blood supply. The bone marrow is the other place where bone gets nutrients. So for now its hard to know how, or if, the bones will be able to mend themselves. Even in a perfect situation one can’t see any regrowth for at least 6 weeks after a break, and given the severity of this situation an additional 6 weeks wouldn’t be much of a surprise. So I’ve got another 2 months of “wait and see” on this front. If the bones are unable to grow, Karch will go in there and drill out the middle of each bone to place rods down the middle. This not only creates additional support, but the drilling action pushes marrow to the surface reinvigorating it which will hopefully stimulate healing. I’d still have a “full” recovery with this method. We didn’t talk about if that doesn’t work, but I think it might be sort of a dead end at that point, meaning we ditch my lower leg and I start shopping for prosthetics.

The second hurdle is infection. Remember, I compounded both bones out the side of the leg. The break actually created a 5 inch incision. Karch joked that I did most of the work for him. Of course I didn’t just rip myself open, I did so out in the woods in the dirt, so a whole lot of crap got into the leg from the get go. Karch gave me 40-70% chance of infection when I left Mammoth, and as “expected” I developed one pretty quickly. From the look of things, the infection was only in the soft tissue, but metal is a magnet for bacteria and I’ve got 17 screws and a plate in there. The 6 weeks of high powered i.v. antibiotics should be enough to kill off any and everything that blood is getting to, but herein lies the problem. There’s no blood supply to the screws and plates now in my leg. If any bacteria found its way to the hardware, my bones are sitting ducks for infection. The fact that the antibiotic treatment is working (signs of infection are slowly receding) is good. This seems to mean that either my bones have some blood supply which is allowing the antibiotics into the area, or even if they don’t, there isn’t any bacteria in there. Whatever the case, the real test comes later - in 4 weeks when I stop taking antibiotics. Once again we wait and see. If I develop an infection at this point, this is a signal that there’s infection deep within the bones or on the hardware. Not good. There’s a few pretty intense options at this point - multiple surgeries to remove and replace hardware and things of this nature. None of these lead to wonderful places. Again the end of this road could be amputation.

Now, all of these bad endings are truly a long ways off and by no means the foreseen outcome. We simply went down each road so that everyone in attendance could get a better idea of what’s actually going on inside my leg and what all these doctors are working with. Karch said one thing towards the end of this sobering conversation that I found very thought provoking.

“I’ve found that almost across the board, when it comes time to amputate a limb, the patient is actually relieved by the prognosis.”

The point here is that IF I go down that road, the path itself will be so long and frustrating (we’re talking a dozen surgeries and possibly years of drama) that the loss of the leg will be welcomed. Think of it this way. I’d come out of that surgery walking, probably running. THAT sounds like fun.

I won’t lie. I left the appointment pretty upset and more than a little scared, but lying here just 24 hours later, I appreciate the knowledge I now have. Its good to know what might be out there. Optimism is more powerful when its educated. Like the climbing I’ve enjoyed over the past decade, I know the risks I’m accepting. However, a faith in the equipment, and more importantly my own strength, grace and fortitude guides me in a positive direction - a direction that almost always keep me out of harms way. This process is not unlike climbing a mountain and I have every intention of continuing to put one foot in front of the other. Every week that passes is mileage ticked and the ever inspiring views bring with them additional motivation to somehow - no matter what - make it to the top.