My Life With Niall - The Long Recovery

Nice to Meet Ya! Part 1

Sunday October 6, 2019

(Jacob's Point of View)

I just woke up when I heard Ni in the monitor and I glance at my alarm clock to see that it's about 6:02 AM. I'm so tired and am hoping to get a little more sleep this morning. He went to sleep around 10:45 last night and was up at 11:30, 12:15, 2:00, 3:10 and 4:30. I've been working with Niall for 5 years now and at this point it has become normal to have pretty sleepless nights. We are now 5 years post his initial surgery but his most recent operation number 15 was about 3 months ago. His knee is healing very very slowly but it is indeed healing. He currently has about 68 degrees range of motion and not much else has changed. He is still on IV pain medication, sleeps with oxygen when needed (as of recent it has been a nightly occurrence), sleeps with his brace locked, uses his game ready, needs a walking aide in the mornings and nights (unfortunately more than just the mornings and nights right now), I still live with him and travel with him 24/7 and he still has his trusty brace on 24/7. The thing that has changed is he is sleeping a little bit better so now he sleeps about 2 hours and on the rare occasion he manages 3 at a time. Aside from that though his knee is still very very severe and very fragile and he gets scans on it weekly. At this point I think he has just come to the point of accepting that his knee is going to take a very long time to heal and that for him complications are inevitable. The sad reality for him is he just turned 26 and nothing in terms of progress has really changed for him with his knee since he was 20 and he had his initial surgery. His body has never really been able to get over the hump of these setbacks he has which just bring him in this gnarly cycle of surgery, recover, PT, learning to walk again, getting 100 degrees of motion, being awake every hour, terrible pain, feeling helpless, making little baby steps of progress, complication, setback, surgery and then the cycle starts all again. At this point we have been through this cycle 15 times. But Niall has remained optimistic and he has learned to just live his life and deal with the obstacles that this situation presents, and I think now that he has accepted this is his situation he has become happier. He has also learned that he can't get down on himself when his knee limits his abilities because the knee is very limiting and he has had to adapt his expectations from himself because a lot of things are just not realistic with his knee right now. As his physician I have also had to adapt my expectations in terms of his recovery because working with him for the past 5 years has taught me and all of his physicians that comparing him to other patients in terms of healing just isn't realistic due to his healing history because of how slow he heals therefore any forward progress he makes is a win for us. In terms of when we think he will be healed fully my best guess is still another 5 years at least if not more. I am hoping in about 5 years we can ween him off the brace full time but until then the brace is going to stay and his crutches, walker, game ready, pain medication, ice, resting, elevation and compression are going to be his best friends still for a long time to come. Another good thing is he had an appointment on Friday and his knee is almost about to reached the pre-healing phase. The cell counts show that his latest surgery has been effective which basically means that between the injected cells from his most recent surgery and his body's ability to make cells he is on the cusp of having enough to be considered the pre-healing phase. This is a huge milestone for him because recently he seems to rarely hit the pre-healing phase before another setback occurs so I am cautiously optimistic. On the downside though earlier last week he came down with little bit of a flu which weakens his immune system. Unfortunately, when he gets sick and his immune system is not at 100% strength his body isn't able to fight infection like it normally can and often times what follows is his knee ends up with a little bit of an infection which is very dangerous for the hardware inside, the healing cartridge transplant, his graphs and his healing bone and it takes away from the cells that can help heal his knee because instead they have to work to fight the infection instead of heal his leg and good cells get killed off. If the infections aren't treated right away they can escalate into a very severe situation very quickly. His knee is a huge risk for infection because his body isn't able to fight off infection as well with the metal because it's all non-organic to the body and bacteria loves the metal. As clean as we keep his knee incision and keep it sealed off from the world the reality is he has a 13 inch entry point into his body that is constantly moist due to his uncontrollable swelling which is the perfect breeding ground for bacteria and the bacteria love the inside of his knee especially the metal. In addition the bacteria that love the metal also love the new graphs and cartlidge. Though his knee gets cleaned 7+ times a day with all sterile things and he gets antibiotics before dental appointments, a Vitamin C IV as soon as I detect he may be getting sick and all precautions are always taken, the reality is the incision continually outputs fluid making him a huge target for bacterial infections. Between medication and keeping his knee very very clean and sterile he is able to avoid most infections but when he gets sick all bets are off and I have to prepare for the fact that he is likely to come down with an infection. Usually when he comes down with an infection in his knee it is pretty immediately so when Friday rolled around and he was still feeling good and his knee seemed to be as well as it can be I was hoping he had avoided this hurdle but yesterday late afternoon he began to show sings that he might have contracted a little bit of an infection in his knee. Late yesterday afternoon he started to get a little fussy which is highly unlike Niall except for when something is really off with him, so I put him on a Vitamin C IV and started him on an antibiotic. Last night he went to bed around his normal time without a problem and I would say he was up a bit more than he has been recently but he goes through phases so once again I wan't certain it was an infection but I had my suspicions and kept a close eye on him last night. The first few times I was up with him last night he was doing well and I though maybe he was just having a bad afternoon yesterday and that was what I was really hoping. But when I got up with him at 4:30 he was incredibly fussy again and his knee was slightly warm, very swollen but nothing out of the ordinary for him but I did not give him pain medication like he would usually get because we are traveling today. But I heard him in the monitor around 5:45 this morning and I need to go check on him before things get out of hand. I am hoping for the best but I do think he has an infection and this is not going to be good if that is the case, because today is going to be a busy day. The Niall 2.0 era has just begun with the release of his new single Nice to Meet Ya and we are headed to NY for a fan event he has tomorrow and then to Toronto. So I need to go check on him now even though I really just want to go back to sleep, but when duty calls you have to get up and go. So I get up and walk out toward the master bedroom. When I get to the door I open it and walk in. He is asleep but he is breathing heavily which means he is in some discomfort. I walk over to the bedside table to look at the IV monitors, his medication is infusing at a good rate and he has had 95% of the antibiotic, which is good. I then turn on the light to look at his leg and his drain, because the drain should be able to tell us a lot about what is happening inside his leg. When I look at the drain I am immediately concerned. He hasn't output much fluid since the last time I changed his drain around 4:30 and that is worrisome because he constantly puts out fluid and right now there is very little fluid and the fluid in the drain is slightly yellow and cloudy. His knee is also starting to budge which puts him at risk for dislocation (which will ruin his surgeries if he dislocates as we will have to redo the surgeries to stabilize him again) immediately know that I am going to get to need some samples of fluid to the hospital and tested this morning so we can start treatment immediately. I quickly grab a pair of gloves, draining kit and a few chucks. I then turn up the oxygen and then I grab a pair of medical scissors. I then remove his game ready and brace but I leave the brace under his leg so that I don't have to move his leg and then I take the scissors and cut off the bandages. Once they are off I put on a pair of gloves. I notice his gauze is hardly wet which is also concerning because he always soils his gauze. His leg is now also really warm and he is very very swollen which is probably a combination of his normal over the top swelling and the fact that he does indeed have an infection and his leg is not really outputting fluid. I carefully remove the waterproof barrier and gauze and I put them in the trash. Immediately my worst fear is confirmed, under the gauze his leg is oozing a yellowish cloudy liquid which is not the normal fluid he produces. I then open the draining kit and I grab an alcohol swab and I clean off his leg and then I put the needle in and I try to draw out fluid. I am unable to draw out much fluid which is very concerning, because his knee is overly full of fluid. I then try to get a larger needle and I am able to get a little bit of fluid out and it's not the right color and it's cloudy looking. I now know that he has a pretty serious infection and I need to get him to the hospital this morning. I quickly change gloves and grab a cleaning kit and I pour the solution into the tray and I use the swabs to put the solution on his leg and I let it air dry. I then change the dressing on it and then I quickly re-bandage his leg and brace his knee. I then turn off the light and I head out of the room to make a few phone calls. It's now almost 7:00. I decide to call Cedars orthopedic department: