Tag Archive | antibiotics

Port Is De-Accessed

Alternately titled: I can give hugs without fear again.

My last dose of antibiotics was Wednesday, which meant I didn’t need my port accessed anymore. Yes – I could get that itchy thing off my shoulder. Bonus, no more danglies hanging off my front. I can wear a bra again, which makes it a little easier to be decent out in public. If I wear a bra, I actually look mostly even again. As soon as my drain access point closes up, I can even take a shower. Such things I have to look forward to.

The Visiting Nurse tried to convince me I had to leave the bandage over my port on for 24 hours. No, not so much. I’ll leave it on for a couple of hours, to make sure the incision site closes. I need to be able to itch that location, and another bandage doesn’t help me scratch.

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.

Successful Surgery

Surgery was scheduled for 6pm last night. The Infectious Agents doctor (I finally learned her name – Dr. Colpan) was disappointed the surgery was last night. She would have wanted to stop my antibiotics beforehand in the hopes of getting a good culture and some idea of the bacteria I’ve got growing inside me. Too bad – I wanted the surgery ASAP so I could get out of here sooner.

Before the surgery, I had to take off all my jewelry (they use a tool to cauterise blood vessels that could cause a spark on metal objects) and all my clothes (luckily, no catheter this time, just a breathing tube). I also had to wipe the area being operated on with a cleansing, antimicrobial wipe. Three minutes with one wipe, let it dry, and three minutes with the other. Three minutes is a lot of time to have to wash a small, tender area.

I had to go to the main OR, instead of the Women’s Hospital’s OR. Dr. Kang took what was available. By 6pm, the OR was pretty empty, so I got lots of attention from all the nurses prepping me. Dr. Kang showed up only a few minutes late and had to complete some paperwork and sign my breast. You have to be sure to mark laterality, just in case.

I was pretty woozy after the surgery and a little nauseous, but I never go to the pukey phase like the last time I had anesthesia. They game me a couple more drugs for nausea this time. My throat was quite dry and sore from the breathing tube, so I woke up every hour or so overnight to get a drink and go back to sleep. This morning, I’m feeling pretty good. I haven’t needed any pain meds, which is pretty awesome. The surgery site hurts every once in a while, but nothing too intense. It is weird not to have the expander in anymore. The right side of my chest is completely flat now. It’s covered in gauze, so I haven’t been able to look at it yet.

I do have two gown patterns to add to the collection:

The gown pattern for the Women's hospital. I've worn several of these during my current hospital stay.

The gown pattern for the Women’s hospital. I’ve worn several of these during my current hospital stay.

The gown from the main hospital's operating room

The gown from the main hospital’s operating room

Now I’m just waiting to see Dr. Kang and probably Dr. Colpan again to tell me when I can go home and what drugs I’ll be taking with me.

 

Surgery It Is

Dr. Kang came by this morning (at 7:45 – I was a bit surprised to see him so early!) . The site is still red, and black spot is visible, and it’s started dripping again. Looks like the expander needs to come out in order for the infection to clear. We tried to save the expander, but (unsurprisingly) it just isn’t happening.

I’m kind of excited to get the expander out (especially because it’s hurt since the beginning of the month, and I’m ready for that to stop) except for one thing. Since there’s an infection in the pocket, Dr. Kang won’t be able to put an implant into the site until the infection clears. That means he’ll be taking the expander out and putting nothing in its place. That makes a pocket where fluid can gather so I need a drain. Blech.

Surgery is scheduled for 6pm tonight. Luckily, Dr. Kang let me have breakfast. No food or drink after 9am. My breakfast arrived at 8:30 – plenty of time to finish before the ban started.

This morning's breakfast - French toast today.

This morning’s breakfast – French toast today.

The other good thing is since I’m already hooked up to an IV, I won’t have to worry about them trying to find a shriveled vein when I go into the OR dehydrated. I did have to get a new IV site yesterday since the old one started infiltrating (which means the fluid was being pumped into the tissue instead of the vein). The timing could have been better, since I was on a Vanco drip at the time. If it had just been the maintenance saline, I could have stayed off the IV until close to 9pm. As it was, I had a half hour or so free of my dancing partner. I took advantage of it and did a couple of trips around the hall.

My new IV site

My new IV site

It was very uncomfortable yesterday and I had a hard time finding a position the arm didn’t ache, but this morning it’s much better. Sleeping with it must have readjusted something since I can use the arm without it hurting today.

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.

In the Hospital

Turns out that area of redness over my expander that started oozing pus was cellulitis, and it had advanced to the stage that Dr. Kang recommended I check myself into the hospital immediately in order to start a course of IV antibiotics that would last days. Lovely – just how I don’t want to spend my time, sitting in a hospital room, hooked up to an IV pole.

My IV pole, complete with antibiotics and two different kinds of saline

My IV pole, complete with antibiotics and two different kinds of saline solution

While Dr. Kang was surprised I didn’t go to the emergency room, instead of scheduling an appointment (I thought I was doing good and seeing a doctor. Who wants to go to the emergency room when you don’t feel like you’re about to die?), going to his office first meant I went right to admissions at the Women’s Hospital. Even so, checking into a hospital after 5pm on a Friday night is not the most efficient of processes. I got checked in and told to go to the fifth floor, where someone would meet me. I made it to the fifth floor, but there was no one around. I even went onto the floor a couple of times. The nursing station I could see was dark, and there was no one around. Back out to the waiting room and my book I went.

Eventually, someone did come out and bring me to a room. I updated my file on the computer, and then proceeded to get poked many times. I needed an IV first. Apparently, while I have a lovely vein at the crook of my arm for drawing blood, any other vein in my arm is tiny. The first vein the IV nurse tried didn’t work, so let’s try above the elbow instead. With all the tape, it makes it uncomfortable to bend or straighten my arm all the way.

My arm after four needle sticks.

My arm after four needle sticks. The allergy tag is for steri-strips.

I also had to provide blood for labs and blood cultures. The blood cultures are to try to narrow down what specifically is causing my infection, in case the doctors want to change the antibiotics I’m getting. They started with the big guns, Vancomycin, so I’m not sure what they’d change to, but knowing what’s causing the infection would be a good thing. The blood cultures need two blood draws, an hour apart, to provide a backup on the analysis (although which one do they believe if the results come back different?). Four needle sticks in two hours has to be a record, even for me.

Blood culture bottles

Blood culture bottles

I’m still waiting to see a doctor to find out how long I’m going to be stuck in this hospital room. It’s a nice room, but I’m still stuck in it. Let’s hope the infection responds rapidly and it’s a small number of days, and not close to that week Dr. Kang mentioned was possible.