Wednesday, November 5, 2008

What's Next for the Wound

First, Dr. K (my main oncologist) and Dr. M (the rad onc) looked at the wound. Overall, they thought it looked fairly well - they were both expecting something a lot worse, but they thought it looked a lot better than when the tissue expander first came out. Dr. M thinks it is highly unlikely that there's anything going on with the bone. Dr. K is inclined to stay the course - that is, just continue monitoring the wound and making sure that it continues to heal. He is going to order a CT scan of just that bone just to make sure nothing is going on. If the healing of the wound plateaus, then we may consider the hyberbaric oxygen treatment or surgery.

Regarding surgery, Dr. K believes that it would be okay for me to have it. He's going to look into whether or not I'd have to go off of Xeloda and Tykerb and if so, then it might only be for a couple of weeks prior to surgery. He doesn't think the risk of recurrence would be too much.

I mentioned that I still have a tissue expander on the left side, which has a metal-backed port, and that I'd like to get it out of my chest. So, that means surgery at some point and if I have to do surgery, then I might as well do reconstruction on the right side. Dr. K agreed - when he said that I couldn't have reconstruction "in your lifetime", he was referring to an implant, but has no qualms about the flap procedure. So, reconstruction is back on the table. And, if I do reconstruction, then they might bring in tissue to protect the bone, if it's needed.

As I understand it, here's the plan of action:

1) In order to encourage the wound to heal more quickly, I start taking Vitamin E and also something called Trental. Trental causes the blood to become less viscous - i.e., it allows red blood cells to go through restricted blood vessels better so that they can bring more oxygen to the wound. Possible side effects include dizziness and nausea. But most tolerate it fairly well. And, I continue with the dressing changes and periodic visits with the wound care nurse, L.

2) I will have another CT scan just to see if anything is going on with the rib bone. If there is something, then perhaps we consider hyperbaric oxygen treatment or surgery.

3) We put reconstruction back on the table. Dr. K will talk with Dr. H (the plastic surgeon) about the timing of this surgery. It may be as early as December or not until March, to work around my teaching schedule.

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