Monday, October 27, 2008

Sigh . . . Why can't I ever be a simple case?

I need to fix my son dinner, so I will try to make this short.

I met with my plastic surgeon today to talk about reconstruction options and also so he can look at the wound.

FACT: The deeper open wound where the tissue expander popped through in August is still healing (I think) but it is very shallow. There is no soft tissue, other than this white plaque/scab, over the rib bone there.

FACT: I am still on an oral chemotherapy (Xeloda) regimen as well as Tykerb, Zometa, and Zoldex.

FACT: I am no longer a candidate for an implant on the right side as that tissue is too damaged after being radiated twice.

FACT: Surgeons don't like to do surgery on people who are immunosuppressed, i.e., people who are on any form of chemotherapy.

FACT: I have attained a "stable" status in terms of my cancer.

UNKNOWN: Whether or not I can have reconstruction on the right side.

UNKNOWN: The possibility exists that there is an infection in that rib bone that only has this scab over it. If I understand Dr. H correctly, if there is some sort of infection there, then that might keep that whole area from really healing. However, I do not have a fever and I do not have any other symptoms of an infection. The wound looks good and clean.

NEXT STEPS: An x-ray and/or some kind of scan to determine whether or not there is an infection in that rib bone. If so, I may require surgery to take out that bone in order to allow the rest of the bone and the tissue to heal. If I do have surgery, then Dr. H would do a lat flap (latisimus dorsi) flap procedure in order to bring in some soft tissue to cover the bone so it can heal. I may then also be able to have some small breast reconstruction on that side. I may have to go off of chemotherapy prior to surgery, but my question is whether or not that means all four of those drugs (Xeloda, Tykerb, Zometa, Zoladex) or just Xeloda. Xeloda is the only true chemotherapy drug I take. Tykerb is a targeted therapy, Zometa strengthens my bone, and Zoladex shuts down my ovary production. Maybe, just maybe, I only have to go off of Xeloda.

NEXT STEPS, Part 2: Keep monitoring the open wound. About half of the wound is healing. The half that is slower to heal is where the tissue expander poked through. If the wound plateaus and doesn't heal, then we look at surgery so that it can heal otherwise I risk getting a bone infection and I have to go off of chemo. If it does heal and if Dr. K (my oncologist) says it's okay for me to go off of chemo, then I may be able to have reconstruction.

So, it's a wait and see game. It never occurred to me that I could get a bone infection! I don't have any symptoms, but more than likely, there is some bacteria in that wound. It's not infected (we don't think) because I don't have a fever or have any other symptoms. The dressings I use there have antimicrobial properties which help keep things from getting infected. But if no soft tissue ever grows there, I run the chance of getting an infection since there is only a really thin superficial scab-like thing over the bone.

Dr. H, the plastic surgeon, isn't quite sure what to do with me as he hasn't had a patient who is taking oral chemotherapy. He and Dr. K have to talk. Dr. K was of the opinion that I couldn't have reconstruction but the reason he gave me was because of the damaged tissue in that area due to radiation. But Dr. H thought that it may also be due to having to go off of chemo.

Confused? I was, but I think I have my story straight. It's complicated. Why can't I/my body take the easy/simple solution?

Sigh . . .

It was a beautiful day out there today - probably in the mid-70s. I am relatively rested from my trip. I'm generally in a good mood. There is much that I'm thankful for! Thanks for your continued support everyone!


Gbex and Ellen said...

hello, wish you have a nice day!!

MisAnthropology said...

Wait. Waiting is ok.

And you can't be a simple case, because you're not a simple person. There's beauty in complexity.

Dee said...

Hi Gbex and Ellen, Thanks for visiting!

And, Mary, you're right. I need to take pride in the complexity. Keeps my doctors on their feet, I guess. I make them think about the treatments they give me - if I was a usual case, then they may just recommend something without getting to know the patient. Being unusual means that they look at ME and treat accordingly.

Waiting is a pain. But I know enough now not to get too tired up into knots - get back to work and to the things that really jazz me up. So, thanks, Mary! I needed that reminder!