NEW PLANNING BEGINS TOWARDS THE "IDIOPATHIC" PROCESS...

Weekly now, I must go to see the Dr. in charge of my infection care.  The name of the infection that was confirmed through testing is Staphylococcus Aurea's.  Evidently this infection is not so rare, especially to craniotomy surgery.  This infection caused Osteomylitis to my temporal bone.

I met with my Infectious Dr. yesterday, he gave me the copies of the process from my hospital stay.  They test my blood work every week for progress.  The infection had compromised my temporal bone and of course affected the "bone flap" so much, it was discarded.  A part of my skull was discarded...so easily done.

Now, for the next 5 weeks, at least...I will be going to get tested and receive the new set of "grenades" to be applied to my PIIC line, 3 times per day.  It has to be every 8 hours, so I have chosen 5am, 1pm, and 9pm. This suits our (my hubby's and mine) daily schedule, since we are early morning people.

In my appointment with the infectious Dr. yesterday, he showed me the results of testing.  I have come at least from the "extreme" to "active" status. 

Here is a Medical Report about the process I am currently in:


Osteomyelitis Of The Skull
Osteomyelitis of the skull is a relatively rare disease. However, the proximity of the brain and the propensity to formation of epidural abscess necessitates prompt diagnosis and definitive early treatment. The skull infection originates from three key sources : (a) Paranasal sinusitis, mastoiditis, or otitis; by direct spread (b) haematogenous spread secondary to bacteraemia or fungaemia; (c) penetrating trauma or craniotomy.
War wounds tend to be more extensive and contaminated than civilian wounds, but principles of treatment are same .
Pain and swelling at the wound site should subside within a few days of closure.  Clinical manifestation of traumatic wound infection may become apparent within days to months after closure.When an infected scalp wound is suspected, treatment should be immediate.⁹   The wound is opened, all purulent material evacuated and suture materials removed, and devitalized tissue excised.  To ensure satisfactory recovery of the exposed skull, the wound should be closed loosely over a drain, which should be removed within 24 to 48 hours.  A single layered closure with an inert suture material, followed by a gentle compressive dressing to obliterate any dead space, are applied⁹.
Staphylococcus species are the commonest culprits, and appropriate systemic antibiotics should be started before culture result is obtained.  Persistence of infection after adequate treatment should suggest subgaleal spread, underlying osteomyelitis, or erroneous identification of the offending organism.  Signs of meningeal irritation, seizures, new focal neurologic deficits, or a decreased level of consciousness may signal penetration of the infection beyond the galea, which warrants a lumbar puncture and a further investigation including a contrast enhanced CT scan and MRI.
Craniotomy infections
Most recent studies report risk of infection of 1 to 3%, although re-operation on glioma patients is associated with rates as high as 11%.¹⁰   This increased risk may be attributed to reopening of surgical wounds and prior irradiation of the scalp.  Other factors contributing to the risk of infection after craniotomy include long duration of surgery, multiple incisions, placement of a drain , foreign body, the presence of a CSF leak, and immunosuppression of the patient.¹¹  Treatment  consists of systemic antibiotics and surgical débridement.  The risk of spreading superficial infection to the deeper layers after craniotomy is sufficiently serious to warrant antibiotic administration even before  cultures are obtained. Early detection of a craniotomy flap infection is important by looking out for the local and systemic signs of  infection. Once infection is identified, the wound must be opened.  All purulent material and visible sutures should be removed, followed by mechanical débridement and irrigation.  Dura should  not be violated unless subdural infection is suspected.  The standard technique is removal of an infected bone flap to prevent it being a nidus for chronic infection.  A subsequent cranioplasty is then done later.


My patient assessment is on the good side.  Almost two weeks since my last craniotomy, I have begun to feel a little more strength.  There are times though when my heart feels so slow, I become very lightheaded.  I continue to become dizzy when walking, so I am using the helps that a great PT gave me at the hospital.  He suggested I widen my gait, putting more space between the footage to attain a stronger foundation.

There are several appointments scheduled for this month and next month.  I need to remember the "full flavor" of my journey.  My family also has many blessings coming our way to include my daughter, Sherry's birthday which happens to be on Easter Sunday this year.  My great nephew, Tyler, graduates from high school at the end of May, which will bring a huge family gathering as well.  And then....my newest grand-daughter, Lucy, is due to be born at the end of May!  Such wonderful days ahead to keep the focus on "life" in the positive!

My family, friends, and neighbors have been so supportive to my latest needs.  How God answers prayers continually, is always amazing!  

So, in the new planning, more testing will begin with my new ENT Dr., my new neurosurgeon, the infectious Dr., support from my neurologist, and of course my hematologist.  Have you ever heard of "meet and greets"???  I pray before those times, knowing God has a reason for me to be there.  That, my friends, is in His Purpose.