On Monday, I saw the plastic surgeon. I asked her why I still had an open wound and the answer was that the bacterial infection (bacterial colony, really) wiped out a lot of the skin graft.
The latisimus flap (the muscle near your shoulder blade) did fill in the big hole created when they took out the cancerous mass. The skin graft was to cover the whole area, but the infection wiped it out.
Dr. T was pleased with the progress of the wound after the infection. Now the whole area is nice red granulated tissue. That tissue will eventually form skin - maybe in about two weeks - but it's going to stall out because the skin can't grow up the "wall" that formed near the back of the wound. Remember when I said that it looked like a ledge? The healthy flesh coming from my back toward my armpit all of a sudden dropped down a 1/2 inch. Well, in order for skin to grow up to that, we need to create a ramp or a slope going down to the granulated tissue, so she used silver nitrite (which is used to cauterize bleeding wounds) to kill some of the tissue at the edge, so it can create a slope that will allow the granulated tissue to grow skin up to that level. There was also an area in the middle of the wound of "hyper-granulation" that needs to be killed so skin can form there. So, we're still in the process of growing tissue. At least I now have an estimate to when I no longer have an open wound. I can handle a couple of weeks. I had a vague idea that it might be months. I'm relieved about that.
Then, yesterday, I saw Dr. K, my oncologist. The assistant noted that it looked like I lost weight. I think I have since surgery as my clothes are looser. I ended up weighing 135 pounds, about 8 pounds less than I did prior to surgery. That was a surprise because when I was in the hospital, I weighed 142. Anyway, I figure I have lost the implant (good for a pound or two), the big mass under my armpit (good for another pound or two), plus I drained a lot of fluid (the whole armpit had edema prior to surgery). I told the nurse that my appetite has been great so I don't think they are too concerned.
I talked to Dr. K about the tumor near my breastbone - I have watched it grow a little bit in the last few weeks since surgery. It seems to want to grow up and out of my skin and now has a little purplish bruise on the skin above it. Also, about an inch up my arm from the port, it seems that part of the catheter comes up to the skin before going down again. I wondered if the port needed to be taken out. He thought that the catheter was okay and also decided that I should start Herceptin again to try to stem the growth of the breastbone tumor. I haven't had chemo for about 7 weeks, so I guess it's time. Eventually, that tumor may be taken out surgically. But I don't feel like thinking about that any time soon. I wonder if I should stat making a poultice of turmeric and aloe vera gel and putting it on that tumor to see if a topical application would help stem the growth? It certainly wouldn't hurt, I guess.
In the meantime, I made it through class yesterday. I asked the students where things stood with their projects and I helped talk them through their literature review. I was pretty tired afterwards - listening for two hours and trying to concentrate on what they were doing. Then I came home, ate lunch, went to wound care, then picked up Eddie, ran an errand, and then saw Dr. K. Whew. I laid down after dinner and I dozed a couple of times through the evening. I didn't get to sleep until late, though. I ran over to the MU for a snack before class and my legs felt shaky afterwards.
I made it through two busy days and didn't feel too tired. Yay! I do try to take it easy when I can. Today, I only have wound care. I might also run an errand or two. Otherwise, I need to grade papers and do some paperwork. My plan is to take Ed to school, come home and rest until I go to wound care, then go back to my office to take care of papers.
Wednesday, April 27, 2011
On Monday, I saw the plastic surgeon. I asked her why I still had an open wound and the answer was that the bacterial infection (bacterial colony, really) wiped out a lot of the skin graft.
Monday, April 25, 2011
On Saturday, it was beautiful here in the Willamette Valley, especially through the early afternoon. It was sunny and nearly 70 degrees out.
I had a sponge bath (no showers yet while the wound in the armpit still heals), then went Easter shopping for Ed and found a couple of button down shirts for me. Then my folks and Eddie and I went to lunch. Then, I took myself to urgent care for a dressing change. I then took Eddie to the park. I rested on the bench while he ran around with a former classmate and a new friend. Then, in the evening, he went to Nerf Gun Night. I dropped him off at 5:30pm and picked him up at 8:30pm.
A busy, almost normal day. I rested between activities.
But yesterday, it was cloudy and rainy. I was lazy. I think the only thing I did was go to urgent care. We watched a couple of movies on Netflix (Salt and one with Julia Stiles called Cry of the Owl which was strange and weird). My brother Kevy came over for dinner with me and my folks. Mom made turkey and other Thanksgiving goodies. It was good! Thanks, mom! (Scotty has been in Albuquerque visiting a friend. Ed went to his dad's.)
The doctor at urgent care, who changed my dressing both days, thought that the wound looked better on Sunday and also thought there may have been less drainage (i.e., less bleeding).
The wound, the last few days, has less serous drainage. Instead, it's bleeding more. I'm not sure if that's a good sign. I'll find out today as I have an appointment with the plastic surgeon. I plan to talk to her about why I wasn't prepared by them for still having an open wound afterwards. I will also tell them how long the wound had the infection - until last Tuesday or 2 1/2 weeks.
I also took the transparent film dressing off the skin graft donor site on my thigh. I was nervous as I thought it would stick, but fortunately, while I had to tug in a couple of places, it didn't stick or hurt. I am able to wear pants with the fabric rubbing on the area without it really bothering me.
So, more progress. I think I will be able to teach tomorrow. Finally!
Friday, April 22, 2011
People have been so kind to me and my family after surgery. I have been the recipient of gifts and my family and I have received meals and other food.
First, I want to thank my colleagues for taking over my class the last few weeks: Bryan, Nancy, Joan, Missy, and Leah.
Second, I want to thank Melissa (a mom in my son's class) who made us a pasta meal and salad and dessert, Rebecka who made a pot pie enough for 2-3 meals, Jyl who made my family hamburger soup while I was in the hospital, Joan who brought over chili and salad, Nancy who brought over cornbread, and Elaine who made us cinnamon rolls.
Third, I want to thank Kai, Phyllis, Beth, and Karen and Brenda for giving me gift certificates for a mani/pedi, for a meal out, and to purchase whatever fun thing for myself.
Finally, I want to thank Alex, who offered to give me a ride this morning (still not released to drive while I'm on Dilaudid - but also because I don't quite have the freedom of motion in my left arm). Plus my folks for taking care of me - my dad for giving me rides to all my many appointments, for my dad and brother for picking up or dropping Eddie off at school, for dad and brother for running to BK for sausage-egg biscuits (I crave protein), for bringing me potato chips (another craving - I think I'm trying to build up my potassium reserves), and for cooking and cleaning around the house.
Thanks again to everyone who continue to keep me in their thoughts, prayers, etc. Everyone who sends me blessings and good energy. I appreciate it all.
It's sunny today. There is much to be thankful for, right?
Thursday, April 21, 2011
The last two days, I've actually worn real clothes.
That's right, I'm wearing jeans and button down shirts! I felt so much more normal. No tubes sticking out of me.
Also, there's no odor in the wound. My body is winning the battle against the bacteria in the wound. My wound care nurse, L., said yesterday that she was impressed with how well my body and immune system was working to fight the bacteria. I said, "But other people are like that, too, right?" and she said, "No, actually, you are in the top 10% in terms of how well your immune system is working. Most people wouldn't be doing so well." She also said that it's due to how well I take care of myself. I added that I think acupuncture has helped my immune system.
As I mentioned before, I think turmeric is really helping the wound. L. also started using collagen on the wound to help my body build tissue.
I was able to go to two appointments yesterday and a friend came to visit. I rested between appointments and before my friend came. That helped.
Today, I'm going to my overload class - it's a 1-credit honors student colloquium that I'm co-teaching with my colleague. He's taken the class the last two weeks and has a good handle on directing the students. I just have to show up today to give my two cents on the readings. They are readings that I have taught before, on traditional ecological knowledge. I don't expect it to take much energy from me. Instead, I expect to gain a bit of energy. My colleague says the students are interested in the subject and are bringing up some interesting insights. My colleague has also really enjoyed the readings I picked, so I'm pleased. It's only 50 min then I plan to come home and rest.
I will still miss my other 2-hour class, though. My other colleague has taken over there - she made some decisions for me since I couldn't even think that far ahead that will or have already helped. I don't think I can handle two hours yet.
I have two other appointments later this afternoon, but will have several hours to rest between times. Which is good because I think I only got about 7 hours sleep last night.
So, more baby steps into the land of the living. Thank you, colleagues! And, thank you to everyone out there for your continued support!
Wednesday, April 20, 2011
I am close to exhausting my sick leave. I also don't have many FMLA eligible hours (too tired to explain), which protect my benefits. I was also under the misconception that if I go on Short Term Disability, my benefits would be paid for. So, I got hold of people in HR to figure out what to do. Actually, I wanted them to lay out my options for me so I could make a decision.
But someone, instead, sent me several websites to read over. It's hard for me, yet, to concentrate. So, I got overwhelmed. I don't know what to do.
I finally talked to the FMLA specialist who finally explained things that helped.
The bottom line is that as long as I work or have enough sick leave to cover half of my work hours in a month, my benefits will be paid in full. I have enough sick leave to cover my benefits for next month. I will be able to work over 50% of my hours in May to cover benefits in June, and will likely have enough in June to cover July. I also expect to do the same next fall, so my benefits will be paid through summer.
That was my biggest worry is whether or not I'd have to pay benefits out of pocket.
I also don't think I will have to take unpaid sick leave this month. Next month is another story. But I may gain enough FMLA hours in May to protect my benefits. I just have to worry about decreased salary, potentially. I don't know how that works.
But just in case, I will go on short-term disability. Even if I have enough sick leave, they will give me $25/week. That might help cover any unpaid sick leave in May. Disability can be back-dated, too. The other good news is that I haven't been spending as much money while I've been home, so now I have some reserve to cover May, in case I need it. And, if I don't, I have some cash to take a little vacation when school lets out in June!
Tuesday, April 19, 2011
Over the weekend, I had less and less drainage from the wound. The JP drain was only collecting about 20 ml of fluid in 24 hours. So, I saw the surgeon yesterday, who pulled the drain out. So, now, finally, no more tubes coming out of me.
There's also less drainage coming from the wound. L., my wound care nurse, was able to debride most of the dead tissue from the wound. So, now I have less dressings. There is also hardly any odor (yay!) and less leakage onto my clothes. I was able to wear a shirt (a pj top, really) for 24 hours without anything getting on it. A record!
I started taking my Chinese herbs, turmeric, and Vitamin D3 over the weekend. I can't prove it, but I swear the turmeric is helping the wound heal!
I feel I can lift my left arm higher, too.
I still have a low grade fever (up to 100 once yesterday) off and on.
But I still tire easily and need to lay down after activity (like after an hour with the wound care nurse). Also, my left calf became achey Sunday evening and it only feels better after I put heat on it. (My sis said, "oh, no, maybe it's deep vein thrombosis!" which made me worry. I don't think I have many of the risk factors, other than laying down a lot and having a long surgery. My leg isn't swollen or red, though, so I don't think I have it.)
My colleague offered to take my class this week. When she came over to visit (thanks for the cornbread, N.!), I was still emotional about things. I'm not quite ready to face students. I get uncomfortable sitting at an upright chair.
But there are improvements. I might even try to wear real clothes today. Or at least, real pants.
Saturday, April 16, 2011
I am finding what my limits are, in terms of pain and levels of activity. I was dismayed and discouraged yesterday afternoon and evening because I got so uncomfortable and tired and tense after a friend came to visit.
I am trying to wean myself off of Dilaudid - Thursday into Friday, I took only one 2-mg dilaudid every 8 or 9 hours. I was fine as long as I stayed home and either sat in my chair or my bed with strategically placed pillows.
But yesterday, I went to wound care and about an hour later, a friend came to visit. Around the time of her visit, it was time for Tylenol - and I ended up taking a dose of dilaudid a few minutes after she left. My friend and I sat at the kitchen table, but I couldn't get my arm comfortable. My back - where they took the lat flap - was achey. My breastbone (sternum) feels pressure. And, where the drain comes out, around my ribs, bothered me. My shoulders were tense. I was restless because all I could think of as we visited was how uncomfortable I was. I couldn't wait to get horizontal in my bed.
Granted, before that, I hadn't been in bed since about 7:30 that morning. I sat in a chair in the living room, cleaned up, then went to wound care, then sat in the chair some more. I think that may be progress.
So, I took dilaudid and laid down and napped off and on all evening.
I was worried last night because I realized that if I can't sit at the table for long - or stand - I won't be able to teach next week. I still find it hard to concentrate for long on any paperwork. I don't know how I'm going to grade papers. It's hard for me to concentrate on what I'm going to say.
I tire easily. An hour with the wound care nurse and about 45 minutes with my friend wiped me out. How can I handle an almost two-hour class? I was also running a low-grade fever (99.4 - 100) last night.
In retrospect, I probably should not have taught our department's 4-credit class. I can probably handle the Honors College class (one-credit) that I'm co-teaching with a colleague. I will probably cancel all other appointments next week except for wound care.
So, recovery is still slow. I guess, when I think about it, it is not unexpected. I was anemic before surgery. They gave me two units during surgery, but my hemoglobin was 7.5 when I came home. It's been hard to retain nutrients - I am on a stool softener because of the dilaudid, but not all my food is digested; then the new antibiotic gave me diarrhea. My appetite is fantastic - I eat a lot. I'm also eating more yogurt to help with digestion. But my body is trying to fight off infections, build new skin and tissue, and fight pain/discomfort.
The good news is that the wound is healing. L., the nurse, took off some dead tissue. The honey dressing really helped with the odor. There is less drainage - from about 90 ml in 24 hours to 60ml yesterday. L. could see good pink tissue under the dead tissue. She was happy with it.
My plan is to take Dilaudid more often (i.e., every 4 or 5 hours, maybe 6), lay down more, rest. I'll see how I feel on Monday. But I tend to think that I may have to talk to my boss about this class . . .
Thursday, April 14, 2011
I saw my regular wound care nurse yesterday. She felt that there might be a residual infection, but that, for the most part, my body is doing what it needs to do to heal the wound under my armpit. Mostly, it's because my body's temperature has hovered between 97.5 and 99.1, which is normal and does not indicate that I have an internal infection.
She also felt there was a little bit of gray necrotic tissue, but that there is healthy pink tissue underneath. That was in the main area of the wound.
The area at the front of my armpit has more drainage and necrotic tissue. She can see staples and also stitches. It makes me wonder if somehow that area was supposed to be closed but got torn open when they took the wound vac off. Or something.
The drainage is still cloudy and tan, which may be more an indication of necrotic tissue than infection. L., my nurse, put a honey dressing on the area. Honey is good for pseudomoniasis (thanks for telling me about that, Amy!). We'll see if she continues with that today or not. It has also helped some with odor.
To be on the safe side, though, my surgeon here in town put me back on antibiotic for another week.
My leg is healing - it itches. It's not very painful anymore. I only have a transparent dressing on it.
There is increased swelling around my left forearm, just below my elbow, and up that arm. Dr. F wanted to put a sleeve on it, but I just don't want to deal with that right now.
So, I'm doing better. I still get tired of sitting up and will lie down on bed. That's a function of trying to keep my left elbow elevated. I end up tensing my left shoulder. It has a permanent knot in it. And on antibiotics to keep away any kind of infection.
Tuesday, April 12, 2011
Yesterday, Dr. F removed one of the drains. I cried a lot, especially to his nurse, mostly because I saw the area under my armpit earlier that morning and saw the defect again. But the drain came out easily.
I then saw the wound care nurse - not my regular one - and she put a dressing on that supposedly wouldn't stick on the donor site on my leg. She changed the dressing under my armpit.
Today, I saw her again (my regular nurse is out of town). We found that the dressing she used did indeed stick some - but we irrigated it well to take off the dressing. It seems that where it drained, it crystallized the silicone on the dressing and that crystallized area stuck between the dressing and my skin. Ouch.
Also, this morning, I noticed that my drainage in the drain tube was cloudier. I showed it to the nurse and she felt that maybe that represented an infection deeper in the wound.
So, I will call Dr. F again so he can culture the fluid and/or the area in my armpit to check for infection. I finish my course of antibiotics tomorrow morning - and it looks like I'll have to continue it.
I'm trying not to think things like MRSA or any other major bug. I hope that's not the case. I'm hoping it's just evidence of necrotic tissue.
Sigh. I will let you know when I know.
Sunday, April 10, 2011
I guess I can say that I am steadily improving. I spent most of yesterday in the front room sitting in a chair (as opposed to on my bed), because various muscles were getting tired of being on the bed. But I found I could do it, so that's a good thing.
I went to Urgent Care yesterday so they could change the dressing under my arm. I could tell that this was not something neither the doctor nor the nurse had experience with, but they were very good at trying to help me - and compassionate, too.
I was able to change the dressing on my leg - the skin graft donor site. The wound care nurse, on Friday, covered the sensitive area with collagen and then just put a transparent plastic dressing over that. Then she covered the whole area in surgical pads and then we wrapped it in an ace bandage. It had leaked a bit on Friday night, so I changed the surgical pads and left the plastic over the sensitive area. The good news is that the plastic does not appear to be sticking to the wound, so less pain - and less time - will be used to change that dressing.
I will go to Urgent Care again this afternoon to have them change the dressing under my arm. I should also say that other than a bit of pseudomoniasis where the JP drains are, the rest of the infection on the skin appears to be gone. I do, however, still have an infection inside. I've been running a low-grade fever off and on. I am still on antibiotics until Wed. I hope the infection clears by then.
I am noticing that I need less of the dilaudid but really need the Tylenol. On Friday, I took my dose of Tylenol a couple of hours early, so then in order not to exceed my 4,000mg/day limit, I had to wait longer than six hours to get the next dose - I ended up taking a partial dose earlier and than another partial dose later and I found myself in more pain. On the other hand, yesterday, after I got back on schedule with the Tylenol, I found I could stretch the time between Dilaudid doses and not really feel anything. I could take 2-4mg every 3 hours. Through the evening and night last night, I stretched it to four hours - and I'm going to try five today. I want to start weaning myself from Dilaudid since it can be very physically addicting.
One of the mom's from Eddie's class brought over dinner yesterday - a delicious penne pasta with salad, garlic bread, and no-bake cookies. Thank you, M! An old friend of mine also sent an American Express Gift Card that I will use for something fun - thank you, P.! While I was in the hospital, one of my grad students brought over dinner for my family - thank you, J.! And, another grad student who works for me will bring over a meal tonight for us to use tomorrow. Thank you, R.! My colleagues also sent me flowers while in the hospital, which were very pretty and fragrant. The nurses said they liked coming into my room because it smelled a lot better than others. Another mom from Eddie's class took Eddie for a playmate last week and another one will take Eddie today, I think. I am grateful to all of you for your help.
So, yes, some improvement. And, that's a good thing.
Thursday, April 7, 2011
I don't think I've written about this before. On Tuesday, when they took off the wound vacuum pump, the docs noted the smell and that I had a pseudomoniasis infection. I guess it's not all that uncommon, especially since I've seen hints of pseudomonasis in the wound off and on (maybe 5 times) in the last six months.
So, while the wound/skin graft is healing under my armpit, the whole area needs to be cleaned with Dakins solution (partly bleach) for a few days. We started this yesterday morning. I was supposed to change the dressing last night but after the trauma of the trip home and one of the interns inadvertently ripping (well, it wasn't quite that bad, but he could've been more gentle) part of the dressing off the skin graft donor site on my thigh, I knew I couldn't face seeing the wound.
I finally got my courage up and changed it this morning. In a way, it's a bit ridiculous to think that I can do it because I really can only use one hand since the other one is lifting my arm up. I also didn't want my family to change it - my sister maybe, but I really didn't want anyone else to see it. Hell, I don't want to see it. But I saw it this morning and the sight affected me. The defect is larger than I thought. I had visions of it being all almost normal, but that's not the case. There's an area of maybe 3-4 inches long and a few inches wide that is about 1/2 inch lower than the rest of my skin. The docs never told me what to expect and I didn't ask.
Anyway, I'm in the process of wrapping my head around the sight of the site. I keep remembering that they were able to get all the cancer. The surgeon said all the margins were clear of cancer. And, that's good.
The wound care nurse thinks that the graft will grow over some of that defect. We will see in time.
I am so glad I saw the the wound care nurse today. She changed the dressing in my armpit - made sure it was clean. She put the Dakins on it and wrapped it all up again.
L. (the wound care nurse) also changed the dressing around the JP drain site. There was a bit of pseudomoniasis around that area, too, so she again cleaned it and put a new dressing on it.
Then, it was time to tackle the donor site on my left thigh. I was not looking forward to it because I knew the dressings were already sticking to the new skin. It's like ripping off a scab to a big strawberry you get from sliding in softball. Anyway, L was gentle again. She cleaned the whole area because there was a hint of pseudomoniasis in the donor site as well. She took off the whole old dressing, then put collagen over the donor site, covered it with oil emulsion dressings (which will NOT stick), then transparent plastic. The whole thing is wrapped in an ace bandage.
So, I have a few sites of drainage. TWo places under my armpit. One by the JP drains, and the donor site. All were leaking onto my clothes. As L. said, if it's leaking, then it's easy enough for bacteria to get in to colonize an area.
In the meantime, she also took my temperature - it was 100.2. I took it again when I got home - it was 99.7. So, I have a low grade fever, probably a reflection of the skin infection.
I am on antibiotics for the next week - maybe two. Hopefully, this will take care of the infection both inside and out.
I feel so much better that L. took care of me. In the end, I have more confidence in her skills to keep infection away than what I witnessed at OHSU in terms of how they take care of wounds. I now have all new dressings. I'm confident the wounds are as clean as possible. And, I don't think I will leak.
It's for those reasons that I still don't really feel like going out in public. I feel too . . . ugly with leaking drains, a bit of an odor, and JP tubes sticking out. Plus, I am tired. It's good to rest, eh?
Tuesday, April 5, 2011
The docs are saying I am progressing well. The wound vac comes off today and I will be discharged tomorrow. I think I will have a dressing over the skin graft for another week.
I was disconnected from the IV pole yesterday but this morning, I had to be reconnected for a few hours. Ey are giving me potassium.
My appetite is back. I have had grapes, crackers, raisin bran, mixed fruit, jello, pear and apple sauce. I think I will order a turkey sandwich.
The swelling is going down in my left hand, but still swollen in my forearm.
I found the lower threshold for pain yesterday - I only had Tylenol yesterday, but by evening, had to take Tylenol with codeine. Now I am mixing dilaudid with reg. Tylenol. The discomfort is okay now.
Each day is better. That is what I try to remember!
Monday, April 4, 2011
I am now 2.5 days post surgery. Slept most of Friday and into Sat. But got restless on Sunday. Couldn't get comfortable and was bored. The thing is that it isn't painful. It just feels heavy. I also starring decreasing the dilaudid by yesterday - maybe No more than 10 doses in24 hours. I heard dilaudid can mMs you nauseous, so I want to get off omit.
So I was give Tylenol with codeine. I hope to switch to extra strength Tylenol, although I think the stuff with codeine helps me sleep. I slept a lot through the evening and night.
Anyway, pulled out my iPad this am because of boredom. I won't go home until Wed or later since they want the wound vacuum pump to cone off first.
Trying to focus on how I am improving everyday. Accept this as all part of the process.