A tale of two right legs

Something happened this weekend that I’ve been dreading for almost a year – ever since we decided to move to Laos.

I have lymphedema. For those of you lucky enough not to know what that is – it’s what happens when your lymphatic vessels are either missing or impaired. This causes your lymph fluid to accumulate in the area (in my case, my legs, especially my right one). Lymph is full of white blood cells and protein, and when it hangs out in tissue instead of filtering back into your tiny lymph vessels and on up to lymph nodes, it’s not good…

Things swell. They stay swollen. The whole area become the perfect breeding ground for any bacteria that finds its way into the limb – putting you at high risk of infections that come on quickly and sometimes require hospitalization so that antibiotics can be administered intravenously. Protein starts to accumulate in the tissues. This causes them to harden, further damaging joints and the delicate network of lymph vessels. Things swell more. Etc.

It sucks.

There’s no cure. That sucks too.

I’ve struggled with my right foot ever since I picked up a nasty infection in the Philippines in 2003. At the time I put the infection down to bad luck – I’d been volunteering in a slum area in Manila, wandering around in sandals, and these things happen, I thought. Eighteen straight days of penicillin killed the awful red streaks that had started to climb up my leg, but my foot was never same.

After that, I always struggled with swelling in that foot when it got hot. I started wearing compression stockings whenever I flew. I oscillated between realizing that I may have a serious problem and ignoring the situation.

Until, last May, two months after Mike and I returned from honeymoon, it became impossible to ignore.

For no apparent reason this time, my right foot swelled up dramatically, and so did my calf. When I gave in and went to find a physical therapist specialized in manual lymphatic drainage massage she measured my legs. My right one was bigger than my left all the way through my thigh.

Six weeks of therapy every couple of days reduced the swelling somewhat, but my therapist and a specialist in LA confirmed what I suspected – this wasn’t going to go away. I needed to start wearing compression stockings every day, do therapy regularly, and avoid risk factors.

What are those risk factors for exacerbating lymphedema worse? Well, flying is one. Heat is another.

When we told my doctor that we were considering moving to Laos she looked appalled.

“Why would you do that?” she asked in her typically abrupt, East European, fashion. “Better you move to Alaska than Laos. If you were my sister I would tell you not to go.”

Mike and I agonized over the decision to come here – my health was our single biggest concern about this move. We knew I’d struggle with the heat in the tropics, and we were worried about the implications of being a two-hour plane flight away from a decent hospital should I pick up another terrible infection. When, we wondered, exactly does risk cross that invisible border between sensible and stupid? But in the end we stocked up on compression stockings, invested in an expensive piece of medical equipment to help me with at-home therapy, and decided to give it a try.

And so far, so good.

I mean, not great. Compression stockings are uncomfortable at the best of times, and particularly frustrating when you’re bathed in sweat. My right foot is permanently swollen, and I sometimes mourn the fact that it will never be pretty again. I was never really a foot-person before, but now I catch myself checking out other women’s feet with a mixture of wonder and envy – the agile play of bone and vessel visible under skin, the beautiful curve of an arch, and their perfectly matched, delicate, naked, ankles. I am perpetually amazed (and occasionally resentful) that people prance around on these works of art, heedless of their good fortune.

But, overall, things have gone pretty well since we arrived here in Laos. I stay cool when possible. I keep my feet up when possible. I wear my stocking. I do my therapy with the pump machine. I treat every break in skin with antiseptic – I’m well aware that one infected mosquito bite on my right leg is all it could take to land me in hospital in Thailand.

Then, this weekend, what I’ve been fearing came to pass. An infection that started with a single nasty-looking nodule blew out in the course of twelve hours into a large, dangerous, angry, swamp of staph.

But the irony is that it’s not my right leg that could well land us on that plane to Bangkok in the next couple of days – it’s Mike’s.

Mike has battled staph before. Four years ago staph infections in his legs resulted in one medical evacuation from Sri Lanka to Singapore, four surgeries, and six months of antibiotics. Now, it looks as if the couple of hours perched on an elephant’s head last Thursday rubbed his shins raw and the opportunistic bacteria has struck again.

As soon as dark purple patches started to spread over his shins and it became apparent what was happening, we pulled up his test results from four years ago to check which antibiotics the staph was resistant to last time and which might have a hope of heading this off at the pass. Then we went looking for a pharmacy. We might not have a decent hospital up here, or many English speaking doctors, but you can buy all sorts of antibiotics over the counter.

So, dear doctor friends across the oceans have chimed in with helpful advice, and Mike’s on six tablets of cloxacillin a day. It’s been 36 hours since he started popping those orange and brown tablets, and he woke up this morning with his whole right leg swollen – his ankle’s so big it was hard to get a shoe on. We lined our feet up this morning and took a photo and laughed a little at our matched pair of mismatched legs, and sighed a little, too.

Now we’re crossing our fingers and watching for the next day or two to see whether cloxacillin is going to win this particular battle or whether we’re off to spend some unscheduled time in Thailand. I’ll keep you posted.