Ramblings on healthcare, medical education, and life with a spinal cord injury
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It’s Baaaaaaccck: HO’s Revenge

Well, it looks like I wasn’t quite out of the woods as far as the HO goes.  Just as the fevers last week from the infection were starting to trail off, something else cropped up.  And the fevers I got were even worse.  Just after I thought I was out of the woods from all those recent ups and downs, I was pulled back in seemingly even deeper.

A brief recap: During a rather odd interaction with derm, I’d been put on Augmentin for a suspected strep infection one week ago this past Friday.  Blood cultures were drawn, but since they take days to come back it was a waiting game.  The weekend was a bit rough, but I was OK during days in the beginning of the week.  But at night my fever would start going up to 38.5°C (about 101.3°F).  We kept an eye on it into the week, but Dr. Stein didn’t think too much of it since I’ve had a history of fevers.  Were it not for what came later, some slight fevers at night would be mostly unremarkable.

Then came Wednesday night, when I spiked back up to 39.5°C (about 103°F) overnight.  My nurse gave me Tylenol, but that didn’t work.  Usually it works quite nicely for me, so the next step was an ice bath.  At 5am.  Freezing ice water and ice all over, followed by my torso, forehead and armpits being covered in ice packs.  It’s really not the  most exciting thing to have to wake up to do at that hour, but it was necessary.  And it brought my temp down to 37.6°C (about 99.7°F).

But when I woke up on Thursday, for the first time, my fever hadn’t subsided.  It was up.  And I felt like crap.  I skipped my morning exercise group and slept late.  After showering and getting ready, I noticed that my right leg seemed a bit swollen and the feeling was somewhat diminished compared to my left leg.  I decided to head down to the gym a bit to try to get some exercise, however light, before lunchtime.  On the way there, I ran into Dr. Stein and told him about it.  He thought the diminished feeling could be a pinched nerve from the chair, but that he would keep an eye on it and the swelling.

Before I was to head to therapy in the afternoon, the feeling was still diminished and the swelling wasn’t gone, so the resident had a look at it.  Her suspicion was a blood clot, which is what I was nervous of, but she indicated Dr. Stein would be returning shortly and he would give me a closer exam.  I told him I would be done at 4:30pm, headed to the gym to do my therapy and wound up stopping early because I was too weak.

When Dr. Stein examined me, he immediately said, “That is classic HO.”  Huh?  I thought I was out of the woods with that one.  He had me palpate a region of my leg that was significantly more rigid than the left leg, and indicated that was the uncalcified bone matrix characteristic of HO.  X-rays taken that evening indicated that the matrix had not calcified and HO had not resulted in any bone formation yet.  But I was quickly put back on the Etidronate as a preventative measure.

As a side note, he felt a blood clot (DVT) was highly unlikely considering the chance of it being HO – but an ultrasound of my ginormous leg was ordered anyway.  And it came back negative.  No clots for me.  Since I’m on Coumadin and I’ve already got an IVC Filter from the surgery, if there WERE any clots, there wouldn’t have been anything else that could be done.  I would have to wait, hope the clot would break, and possibly the swelling would go down.  And possibly I would be stuck with the swelling.  Yes.  It might never go down.

Side note: patients with recent SCI are at very high risk for DVT and pulmonary embolism.

The swelling, fevers and general malaise,  Dr. Stein explained to be due to the body’s inflammatory response to the HO attempting to rebound.  The idea would be that the meds will fight off the HO, the inflammation will subside, and the swelling will go down.  I certainly hope it works out that nicely…  But only time will tell.

That night, I again faced  39.5°C (about 103°F) fevers and received another series of ice baths and ice packs.  When I woke up in the morning, though, my temp was normal and I felt MUCH better.  I went to my morning group exercise, felt much more cheerful, and ran through the whole day feeling as though I was completely back to normal.  And my temperature stayed normal.  The only odd part was that the swelling got worse on Friday.  I presume the inflammatory response just hadn’t quite been quelled by the meds yet.

That earlier seemingly unremarkable series of fevers and weakness?  I suspect that had more to do with the HO rebounding than anything else.  It wouldn’t make sense for it to still be the strep infection, since at that point I’d already been on antibiotics for days at that point.  Not so unremarkable when considered in that context.

It’s been slightly elevated in the evenings, but it seems like it’s falling back into range.  And I’m feeling normal again, both emotionally and physically, for the first time in what seems like forever.  So although I’m dealing with HO again, I am on the right meds and am hoping the absurdly swollen leg (it’s about twice as big as my left leg) will start to reduce over the coming week.

It feels good to be back on track.  Now if I can get my regular wheelchair back tomorrow (as I’ve been promised), I’ll be ecstatic.  Guess I have to tell that story too…

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