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Lots of Checkups

The doctors keep checking up on me, just to make sure everything’s going fine. I know it’s going fine, but they need to check and see. I had a final checkup with Dr. Kang last week. I won’t need to see him for six more months and then we’ll have the discussion about whether we can put in the implant. Until then, I’ll just get by with a formed bra. One of these days I’ll head over to the Pennsylvania Artificial Limb and Brace Company to get my self a real prosthetic.

This week, I had some internal check-ups. A MuGA and a mammogram. I had a different technician for my mammogram, and she had a hard time getting the right position for the side-ways mammogram. She kept getting my shoulder pinched in the machine. Even less comfortable than just getting my breast squished. No results from either test, which I’m sure means they’ll be fine.

Next week, no doctor’s appointments. Hooray! I’ll have time to do some work around the house.

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Stitches Are Out!

Yesterday, I was back at Dr. Kang’s office to get my stitches out. He started by taking out every other stitch, and then said he’d take out the remaining stitches if everything looked good. Considering it’s healed completely, all the stitches came out. It was not the most pleasant of operations. Not as bad as getting a drain pulled out of you, but I could feel the stitches as he pulled them far enough away from my body that he could snip it off. I will admit to not watching. I can watch this kind of stuff in other people, but if I watch certain procedures on myself, I get a little woozy.

I asked Dr. Kang what was next. He said I have three possible options. Option #1 – I do nothing, and just leave the site as is. I would feel like I wasted all that effort with the expander, but it’s really nice not having an expander in place right now, and I’m not in a hurry to change things. If I decide I want to do something, I’ll have to wait four to six months and then, Option #2 – he’s able to put an implant in place. It’ll probably be smaller than originally planned for, but it would be something. If the skin isn’t stretchy enough, I may have to go with Option #3 if I want reconstruction – the placement of a new expander.

I already know that Option #3 is out. There’s no way I’m doing another expander. The question just becomes, do I want the implant, or do I say screw it and stick with what I have now. I’m not going to make that decision now. In fact, I can wait years if I want to and then finish reconstruction. I’ll wait until the pain and annoyance of the expander has faded significantly, and see what it’s like living lopsided before I make that decision.

I do have pictures. Not everyone will want to see them, so I’ll bury them under a bunch of whitespace. Scroll down if you’re interested in before and after the stitches come out. Close it out here if you’re not interested. You’ve been warned!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

With the stitches still in. There's a lot of dry skin around the whole area, and you can see my drain incision site.

With the stitches still in. There’s a lot of dry skin around the whole area, and you can see my drain incision site.

Stitches out. You can see how the whole thing looks kind of like a crater, and the skin doesn't slide along the incision site.

Stitches out. You can see how the whole thing looks kind of like a crater, and the skin doesn’t slide along the incision site.

Drain Is Out!!!

I feel so much freer today, now that my drain is out! It wasn’t nearly as uncomfortable as the drain from my mastectomy, partly because it went into my chest instead of into my armpit. Even so, I am thrilled to have it out.

Friday I called Dr. Kang about getting the drain out, because it had drained less than 30cc in 24 hours (the requirement for removing the drain). Even so, he wanted to leave the drain in until early in the week because of the severity of the infection. Being the model patient (would it result in me having to go back to the hospital if I don’t follow directions? Well then, let me follow the directions to the letter), I waited patiently all weekend and called Dr. Kang’s office again Monday morning. They managed to schedule me an appointment in between the visiting nurse coming at 10:30 to give me my antibiotics and draw blood and teaching at 3.

When I got to his office, the nurse apologetically made some comment about not being sure Dr. Kang would take the drain out, since she hadn’t had a chance to clear it with him. Luckily, he was satisfied with the drain output (20-25cc since Thursday) and took it out. Oh my, was it uncomfortable when he took out the drain. First he has to cut the stitch holding it in, and the he has to pull, and I could feel the drain under my skin as he pulled it out. Blech. One big bandaid over the incision site, and I was off and running.

The next big step is getting my port de-accessed, and I will have nothing dangling from my skin, unlike the picture below.

Aren't I just a mess - gauze pad covering my surgery site, drain dangling from a lanyard, and IV tubing from my port.

Aren’t I just a mess – gauze pad covering my surgery site, drain dangling from a lanyard, and IV tubing from my port.

 

Home All Day

It was so lovely to wake up in my own house, eat my own food, and have a delightful cup of tea with breakfast. Everything is not perfect (I still have a drain and numerous stitches), but I’m home so it’s better.

The visiting nurse came by at lunch time to check out my incision and administer my antibiotics. I got a big box via courier yesterday evening, full of everything needed to keep the wee beasties growing in my body dying at a rapid pace.

Seven days of antibiotics

Seven days of antibiotics

The antibiotics get pushed into my IV line over a two minute period. First you have to flush the port with saline, checking for a blood return. Then you push the antibiotics, then you flush with saline again, and finish with a Heparin flush (to prevent clots). The nurse asked if I had anyone in the house who could manage the process. No, I don’t think StatsGuy is up for such activities. Please send a nurse every day to do the antibiotics.

All the other items for flushing the port.

All the other items for flushing the port.

Finally Home

I finally made it home today. I was really banking on coming home last night, but it just didn’t happen. Dr. Colpan wanted to see what the cultures would grow so she could give me a specific antibiotic when I left, and it hadn’t been enough time since the surgery yet. So, I had to stay another night. While I understood intellectually why I needed to stay, I was heartbroken that I had to stay another night. I spent the night alternating between watching mindless TV, doing needlepoint on the family “I’m too sick to do anything else” embroidery, and crying. It was not a good night, which wasn’t helped by the fact that I couldn’t fall asleep.

The family's -itis embroidery.

The family’s -itis embroidery.

I woke up this morning in pretty much the same mood as last night. I’m sure the mood wasn’t helped by the pain in my arm from the Vancomycin. I asked the nurse to take the IV out as soon as my 5am dose was done. Even if I needed another dose, I’d need a new IV site because the one they were using hurt too much. I can’t even straighten out my arm because of the pain around the elbow. That’s a big bummer, since I’m trying to lay off my right arm so I don’t aggravate the drain. Luckily, I was done with the Vancomycin. I got to spend all morning not being attached to a machine.

My cultures finally came back positive – Staphyloccocus aureas, a common skin bacteria, and not the MRSA variety (although Vancomycin is used for MRSA). I got sent home with a prescription for a week of IV antibiotics that the Visiting Nurses will help me with. Turns out, they are equipped to access a port, so I didn’t have to get a PICC line. It does mean I have to leave the needle in that accesses my port for a week. That tape is going to be rough coming off.

My port all accessed and ready for antibiotics

My port all accessed and ready for antibiotics

We settled on a slightly more general antibiotic that can be given as an IV push once a day, as opposed to a more specific to Staph antibiotic that I would need infused three times a day, or oral antibiotics that might not get the job done and would require I go back to the hospital to get accessed for those IV antibiotics. Give me the drugs that decrease the chance I come back to the hospital, thank you very much.

That hospital's version of my antibiotic. In through the port this time.

That hospital’s version of my antibiotic. In through the port this time.

It felt weird to be home. There was a bit of sensory overload after six days in the hospital. Even so, I wouldn’t trade it for anything.

I’ve Entered the Despair Phase

When I first was admitted to the hospital, I was furious that I would have to spend days in the hospital. Who wants to spend days in the hospital? Stupid expander. Stupid infection. Can’t it all just be over. Now I’m at the point where I’m feel I’m never going to get out of the hospital. I’m not bored – just tired of being hooked up to an IV tree and stuck inside.

The lovely view out my window

The lovely view out my window

Today’s doctor’s visits didn’t go as well as yesterday’s visits. The Infectious Agents (IA) doctor wants the expander out (which is what Dr. Kang said they would say). Dr. Kang wasn’t quite as positive for today’s visit. While the redness seems to have declined (although the IA disagreed with that assessment), there’s a black spot within the oozy spot. Most likely, that blackness is the expander showing through. If we can see the expander, the sore will not heal over it and we’ll just need to take the expander out. It could be OK, but the spot will need to be gone tomorrow morning. Otherwise, it’s time to plan surgery.

Surgery will entail taking out the expander, cleaning out the area, and letting it heal with nothing in the space. I would actually be happy if we got the expander out. The big negative would be since we wouldn’t put anything in that space, I would need a drain. I HATE drains with a burning passion. Drains ruin my life. Once everything heals, Dr. Kang would go back and put in the implant. I’m torn – getting the expander out is a major bonus, but having a drain is one of the worst things.

Best case scenario, I could have surgery tomorrow night and be home within 24 hours. It depends on the availability of the OR. Tomorrow morning I’ll know more. It’s all so up in the air and dependent on how things are looking. We’ll see how it looks in the morning.

Improvements

It seems that the antibiotics are working. I saw Dr. Kang yesterday and he thought the redness had decreased since the day before. When I woke up this morning, I thought it had improved even more. The oozy spot seems to be smaller as well, and not as oozy. (I’ll save you the pictures.) Dr. Kang said if the infection continues to respond to the IV antibiotics, they’ll put me on oral antibiotics on Monday. If those work, I could leave on Tuesday, and still have the exchange surgery on the 10th. Good news to my ears. If the antibiotics aren’t working well enough, the expander needs to come out while I’m in the hospital, and the implant will be put in at a later date.

I saw the Infectious Diseases doctor yesterday as well. She wasn’t very helpful. She talked a lot, but I realized when she left, she didn’t say much of anything. The one bit of information she passed on what that it didn’t seem likely the blood cultures would come back positive for anything. I wasn’t showing any signs of infection (like a fever) beyond the localized site. (My nurse this morning said the 24 hour preliminary blood cultures came back negative.) Since they wouldn’t have any detailed information, they’d just keep me on the Vancomycin.

I slept better last night, once I was able to go to sleep. I’m sure it helped I didn’t have the nasty squeeze-your-leg wraps on. They’re used to make sure you don’t get blood clots because you’re not up and around. Thing is, I’m up and around, so I don’t need my legs squeezed regularly. The only thing worse than the squeeze-your-leg wraps is the fact the nurses need to monitor my kidney function. So, every time I pee, I’m supposed to pee into a “hat” in my toilet and then call the nurse to empty it.

The hat in my toilet

The hat in my toilet – so lovely

I did have a lovely breakfast this morning.

Breakfast - I've learned to order lots of things so I get a full meal.

Breakfast – I’ve learned to order lots of things so I get a full meal.

I’ve got leftover Thai for lunch, and Firefly on TV for the day. Should keep me occupied for a while as I wait for my antibiotics every eight hours, and another visit from Dr. Kang.