文章最初发表于2023年春季 监视器 杂志.
随着2022年接近尾声, Audra Harden had two last-minute goals that she was determined to cross off her list before heading into the new year. The first was to be able to st和 和 sing with the choir at 澳门新葡新京’s employee Christmas party on Dec. 9. The second was to dance – even just for a few minutes – with her husb和, 韦斯变硬, 在他的年度军事舞会上.
对一些人来说，这些目标可能听起来很简单. 但是去年夏天, the chance of Audra never being able to dance or even walk again was a very real possibility after she developed a mysterious 和 painful wound on her ankle. Audra initially sought care at healthcare facilities near her home 和 was misdiagnosed several times before her search for answers led her to 澳门新葡新京, 她在哪里担任招聘专员.
“I think my determination to stay positive during all of this was largely due to the people who were around me 和 who cared for me – my nurses, 我的医生, 每个人都,奥德拉说, 32, 马耳他. “融合有很多人才. 如果没有他们，毫无疑问我就会失去我的脚.”
“Once I went off the steroid, the swelling came back with a vengeance,奥德拉说. “我已经完全不能走路了. 我的脚踝疼，摸起来很热.”
Audra sought medical attention again, this time at an emergency department near her home. 怀疑病因可能是血块, the staff did a series of scans before sending Audra home with another prescription 和 a recommendation to call her primary care physician. 对缺乏答案感到沮丧, 这个周末，奥德拉靠在一把扶手椅上度过, 她从哪里开始做自己的研究. 她发现溃疡性结肠炎, a chronic gastrointestinal condition she had been diagnosed with several years prior, 会导致关节疼痛(见框). 想知道这是不是肿胀的原因, she picked up the phone 和 scheduled an appointment with Isabel Manzanillo-DeVore, DO, 费尔菲尔德医疗专业胃肠病学中心.
由于担心奥德拉的脚踝状况. Manzanillo- DeVore referred Audra to 融合’s emergency department for further diagnostics. 经过一系列的扫描, 奥德拉被送进医院的骨科病房观察. 第一天晚上她睡得很好, 但当她第二天早上醒来时, 她的病情迅速恶化.
“I was in excruciating pain; I had probably gone from a six to a 10 overnight in terms of pain level, 而且都局限在我的脚踝上,奥德拉说. “It was starting to turn purple, 和 it had swelled up so much, you couldn’t even see it anymore.”
在奥德拉入住的头几天里, 她接受了整形外科医生马克·多诺弗里奥的两次手术, MD, 俄亥俄州骨科中心的医生, 为了排出她脚踝上开始形成的大溃疡. 尽管做了这些努力，溃疡还是拒绝了
愈合并开始恶化. 她还在与剧烈的疼痛作斗争. Audra回忆起骨科的护士们, 尤其是丽莎·斯科特, RN, went above 和 beyond to help keep her as comfortable as possible post-surgery.
“They had to put me on oxygen because I was in so much pain, I kept losing my breath,奥德拉说. “丽莎对我的照顾是我永远不会忘记的. 她真是太了不起了. 她就像我的天使.”
手术引流管已经失效了, Audra’s perplexing case was brought to the attention of 融合 infectious disease practitioner Andrew Dagg-Murry, MD. 在检查了奥德拉的脚踝后. Dagg-Murry started to suspect that the ulcer was the result of a rare condition called pyoderma gangrenosum.
“这可能是一个很难做出的诊断, but when I saw how bad the condition of her foot was after the procedure, 和 how rapidly the other side of her ankle was developing a similar picture, 我很怀疑我们要对付的就是这个,他说.
Dr. Dagg-Murry说 he typically only sees about five cases of pyoderma gangrenosum every year. 这种疾病与许多自身免疫性疾病有关, 比如溃疡性结肠炎, 类风湿关节炎和白血病(见第7页方框). 原因尚不清楚, but it appears to be driven by a defect in the immune system where the body attacks itself. 坏疽性脓皮病如果不及时治疗是非常危险的.
“我想如果Audra年纪大一点或者身体不好的话, 她可能最终被截肢了膝盖以下,” Dr. Dagg-Murry说. “The wound, 和 the degree of involvement around the ankle, was very significant.”
With the intent of not irritating the highly sensitive ulcer any further, 奥德拉的治疗计划包括非常具体的清洁和敷料, as well as a high dose of steroids to bring her ulcerative colitis under control. 她被告知康复过程会
需要几个月, 但在她的护理团队的帮助下, 奥德拉立刻看到了远处的一线希望.
“Dr. Dagg-Murry’s bedside manners were amazing 和 compassionate; he took the time to listen, 我从来没觉得他急着去找下一个病人,奥德拉说. “My wound nurse Carrie Chesser was the same; she would do my cleanings every day, 和 she was always so charismatic 和 upbeat 和 positive. She would tell me everything she was going to do, so I wasn’t sitting there freaking out.”
As the days passed, Audra’s condition improved, but there was a lot of work still left to do. 她和韦斯不得不在家里学习如何清洁和包扎她的伤口, 她必须戒掉羟考酮, 她一直在服用一种极易上瘾的阿片类药物来止痛. Audra also had follow-up appointments with the Wound Clinic, where Dr. Dagg-Murry 和 his team continued to impress her with their expertise 和 compassion.
“当我出院的时候, the plan was for me to start drug infusion therapy right away to keep my ulcerative colitis under control, 但我的保险出了点问题,奥德拉说. 大约等了三周后，他的医生说. Dagg-Murry介入了. 他对我说，‘我会帮你处理好这件事的，’他确实这么做了. 他和他的队友们的接球非常漂亮.”
秋天的时候. Dagg-Murry also encouraged Audra to begin physical therapy so she could graduate from a knee scooter to walking. 到了12月，Audra又重新站起来了. 忠于自己的目标, she 和 her husb和 celebrated Christmas 和 her return to health with a special dance at the military ball. 现在，她把目光投向了新的里程碑.
“我又开始跑步了, which is something I’m very excited about because I’ve always been a runner,奥德拉说. “I also want to raise awareness 和 be a motivational speaker for people who are going through ulcerative colitis, 或者任何形式的伤害. Ulcerative colitis is a common condition, but it’s not talked about enough for awareness.”
Dr. Dagg-Murry说 he credits Audra for the strength 和 determination she showed in what has been a long 和 difficult process toward healing. “每次见到她，我们都觉得她进步很大, 但这是在她丈夫和家人的帮助下完成的, 以及她愿意相信我们会引导她康复,他说.
