My First Running Injury - An Infected Wound
Since I started running marathons I have been thinking that one day I would face a set back from an injury. I used to imagine how I would deal with shin splints, Achilles tendonitis and stress fractures. I never thought that my first running injury would be so far from my expectation.
What started out as pretty harmless flesh wounds developed into five days of hospitalisation with two visits to the operating theatre and multiple bags of intravenous and antibiotics drips. This experience made me realise that I am exposed to other types of injury or accident as I dabble into trail running in Hong Kong, especially during rainy season. It was only an accident and I have done everything right. Looking on the bright side, I am already through the worst, recovering well and looking forward to running with this beautiful view again.
I am sharing this story so that all runners and non-runners alike will take their injuries seriously, particularly if they have open wounds. Mine started as a lacerated elbow but even a smaller abrasion can develop into a nasty infection if not cleaned, cared for and dressed properly. If you are ever in doubt about your wounds, always seek professional medical help and never turn down the opportunity of daily dressing change by nurses or medical professionals.
So here is my story.
Day 1 - The Fall
Two weeks ago during a group night run (Wed 4 Sep), I slipped on a paved but gritty downhill path off the top of Victoria Peak Park. It has been raining for a couple of days so the road surface was greasy and moist with sand and rocks. I don't remember exactly how the fall happened. I just slipped, lost control, and the next second I was lying flat on one side, with a lacerated right elbow and right knee abrasion.
It was dark so I couldn't tell how bad the injuries were, just that I was bleeding and possibly covered in mud. I couldn't feel pain until I started walking a few minutes later. I was probably in shock. At least I was able to get up and walk all the way back down to the Peak Galleria to get a cab to the hospital. As I was walking down, I called my husband to bring my ID card, medical card and a change of clothes and meet me at the hospital.
There was little waiting at the urgent care in the hospital because it was late in the evening. The nurse cleaned my wounds before the doctor arrived. Then the doctor put five sutures on my elbow and got the nurse to put normal dressing on my knee. He told me to come back for one dressing change in two days time. I spent the entire night wide awake because they gave me local anaesthetic with epinephrine. I decided I would need at least two days off. (Hm...now as I type it, I know three weeks would be more realistic.)
Day 3 - Daily Dressing Change
On Friday (6 Sep) I went to the hospital for my first dressing, my knee abrasion was very raw. Seeing my condition, the nurse invited me to come back to the hospital for daily dressing change, so they could better monitor my wounds for infection. I gladly took up the offer because I had little clue of how to clean and dress my wounds anyway.
Initially I felt so lucky to get away with only flesh wounds. The pain was bearable and I could carry on life as normal. This meant I could still fly out to New York the following week as planned. I only needed to find a doctor there to remove the sutures in 10-14 days which should be fine. So I thought.
Day 4 - Trail Running
I took two days off running since my fall on Wed (4 Sep) because of some throbbing pain. On Saturday (7 Sep) I felt better and went for a really easy 7 mile trail run. I felt great after the run but my elbow swelled even more afterwards.
Straight after the trail run, I went to the hospital for my dressing change. The nurse was concerned about my swollen elbow and advised me to see the urgent care doctor. He was a different doctor from the first one I met on Wednesday night. The doctor ordered an x-ray and fortunately he saw no broken bone or fracture. He said it could be an infection from the initial injury, and the inflammation would typically show up or worsen on day two or three. He prescribed some antibiotics and NSAIDs for the infection. I thought everything would be alright and New York would be happening.
Day 5 - Admitted to the Hospital
On Sunday (8 Sep), things took a worse turn. My elbow swelled up more, turned pink and grew hot to the touch. I went for my dressing change in the afternoon. The nurses looked even more worried and made me see a third urgent care doctor. The doctor admitted me to the hospital right away and said I might need a surgery. He contacted the orthopaedic surgeon, asked me to start fasting, put me under IV and antibiotics drips ready for a possible surgery in the evening.
I am so grateful for this last urgent care doctor. He got the diagnosis right away and he didn't forget my knee wound. He even found a special silver dressing for my knee and arranged for the wound nurse to look after me the following days.
The surgeon arrived late afternoon/ early evening of Sunday. He saw that I was hardly showing any symptoms of an infection like fever, headaches, nausea, high blood pressure, except for a swelling arm, he didn't want to operate unnecessarily. He suspected it could be some excess blood fluid and made me put my arm up overnight, hopefully my body could drain away the fluid on its own. I could eat that evening, but they kept me on IV drips and told me to start fasting again from 9am Monday, and standby for an operation.
Day 6 - Incision & Drainage
Monday morning I woke up to an even bigger, redder and warmer elbow, which was starting to look like a papaya or a lobster. By then I knew I would have to cancel my New York trip. The surgeon arrived early afternoon and saw my lobster elbow. He suspected it was an infection but wanted to make 100% sure before operating on me. So he stuck a massive needle to my elbow to draw some blood to check. It was P-A-I-N-F-U-L. The blood in the syringe was pussy. Bad news. It was an infection. I needed an operation. I didn't know what to think. I was just relieved to see some form of resolution and that giant needle out of my elbow!
The surgeon operated on me right away under general anaesthetics and drained 10 ml of infected fluid. It was called an "incision and drainage" procedure. My blood was sent to the lab for analysis. My wound was left open for two more days (Tues and Wed) to continue draining and to be cleaned daily. The cleaning was also painful like I have never experienced before, he poured IODINE on my open wound! Well, at least it was super clean.
On Wed (11 Sep) the surgeon switched me to a different group of antibiotics, because the lab results showed three bacteria in my infected wound and the original antibiotics were only effective on two of the three bacteria. The nurses said where I fell was extremely dirty. Typically they would only see one or two bacteria in an infection like this.
Days 7 & 8 - Open Wound
After the operation, the surgeon said that he was surprised that my immune system was strong that I wasn't showing many symptoms except for a swelling arm. Yeah, I didn't know whether I should feel good about my immune system. I thought by then I have had three or four days worth of antibiotics drips through my veins. My immunity was "total kaputt" and even my pee must be sterile. Number two business was totally off and I asked the surgeon to prescribe some probiotics.
Day 9 - Debridement
On Thursday, I was back in the operating theatre to have my elbow and knee debridement and my elbow stitched up. I felt dizzy for hours afterwards but at the same time I was really looking forward to leaving the hospital. I couldn't sleep well so the nurse gave me another painkiller. I wonder if the nurses always hand out painkillers when they see patients awake at night? I wouldn't mind they also gave out some dark chocolate. =D
Day 10 - Discharged
On Friday 13 September, the surgeon came to see me one last time to check for any reaction from the sutures. It was ok and I was finally discharged! I was so thrilled to be leaving the hospital and also feeling totally wrecked after days of antibiotics. I have pulled all the tools and tricks I have learned from nutrition school to keep a positive attitude, breath deep, eat, sleep and move as well as I could during my stay. Five days ago I rocked up to the hospital broadly healthy with a couple of injuries, but as I walked out I felt spent, like I have emptied my tank to fight a battle. I was just so glad to finally get my hair washed, to sleep in my own bed and to eat some real food.
Today (18 Sep) I was back at the hospital for an appointment with the surgeon and saw the wound nurse who took care of my knee. The stitches on my elbow are still in place and my knee is healing slowly. I will avoid running or vigorous movement so both my elbow and knee can heal better. We've already scheduled an appointment to remove the stitches on 26 September. It looks like my knee will take another 2-3 weeks to heal properly. I am definitely on the mend!
I also have the luxury of worrying about NYC marathon 3 November. It will be challenging but it is such a good problem to have!