My boyfriend and I continued to treat his wound with the Bactroban ointment and a gauze pad and just as the surgeon predicted, it continued to do very well. When we went back to the wound care center the following week even I was pleased with how small it had gotten. The surgeon was also happy with its progress and told us that we should continue using the ointment for a week and then after that just to cover it to provide some protection, by that point it would probably be closed. The surgeon said that he wouldn’t be able to see us for a few weeks but to make an appointment for three weeks later. We made the appointment for three weeks later and left.
It has now been a little over eight weeks since I have been discharged from the wound care center and approximately three weeks since my visiting nurses have stopped. I am still diligent about making sure that I do not stay in one position for very long and still periodically have my boyfriend check to make sure that my wound is closed. It was still closed after seven weeks so I decided that my dad’s birthday was when I was going to officially tell him the good news. I wrote the dates that I had been discharged, in his birthday card. He was incredibly happy to hear that I had been discharged, and while I suspect that he knew already, he did not say anything. My family and I were just starting to adjust to me being fully discharged when a few days ago I started to get a bad feeling.
I cannot explain what I felt, other than to call it a “gut feeling” I feared that my wound had reopened. I tried to remind myself that I had had that feeling before since I had been discharged and each time my wound had remained closed so I was probably just overreacting. When my boyfriend was here two days ago, I asked him if he would please check for me because I was really nervous, because the day before I thought I may have seen a little bit of drainage in my clothing.
As soon as my boyfriend saw my wound he said, “Yeah, it’s opened”. I was not surprised by what he said but I still needed to see it for myself. He showed me a picture of it and sure enough, a tiny portion, the same part that had opened previously was open again. I took a minute to just stare at the photo in disbelief that this had happened again. I was so upset that I could hardly form coherent thoughts to have a conversation with my boyfriend. At that point, admittedly I got a little more emotional than I usually do; all my boyfriend could do was hold me.
After a few minutes I needed some insight from someone that was a little more removed from the situation so I sent my best friend a text message. Explaining that it was open again and I had no more coping skills left and needed her suggestions. After she got over the initial shock, she suggested that I call the wound care center and see if someone could see me. She also told me that I should try to relax and zone out and forget about things for a while.
I was really upset that my wound had reopened; I also could not believe that it had happened just a few days after telling my family that I was fine. I realize it was just a coincidence but I couldn’t help but think that my making the announcement had somehow caused it to open again. By that point, I knew a decision had to be made about whom I was going to call. I decided to take my friend’s advice and call the wound care center and explain the situation. I did not want to call my visiting nurses because I knew that if one of them appeared it would instantly cause drama in my family and I could not put them through that again. When I called the wound care center the receptionist originally thought I was playing an early April Fool’s joke on them, once I explained that I was serious she began to check the schedule to see what could be done about getting me seen. She was able to make an appointment for me for the week before the surgeon comes back, with the doctor that I had seen when he was out of town before. She then asked me to hold on while she spoke to the nurse that I was most comfortable with at the wound care center. When she came back to the phone she told me that the nurse had suggested I just cover the wound with a clean dry dressing until I could get to the appointment.
My boyfriend covered my wound with one of the few dressings I have left, a Tegaderm Foam Adhesive and we just tried to relax and not worry too much. I go back to the wound care center next week so I am just trying to remain positive, until I get told just what is going on; if the part that reopened is just superficial or if it has depth and will therefore need more treatment.
Thursday, March 21, 2013
Saturday, March 9, 2013
What The Hell is Happening Now?
I know it has been a long time since my last post. I apologize; it is just that my boyfriend and I do not live together and I haven’t actually been able to see his wound in person very often.
His wound was doing incredibly well; it was appearing much smaller and had no signs of infection. Just as I was beginning to relax, he threw me a curve ball. He sent me a text message two weeks ago on the day that he had an appointment at the wound care center. He told me that when he woke up, he discovered a blood blister directly above the wound and asked me what he should do to cover it because he was worried that the dressings he was using would cause it to pop. At first I thought he was just messing with my head and trying to get a reaction out of me by claiming to have a blood blister so I told him to prove it. Minutes later I received a picture of what in fact was a blood blister.
I took a breath and picked up the phone and called him. I asked what size dressings he had, hoping against hope that he had one that would be big enough and loose enough to cover the entire wound, including the blood blister, without being so tight that it would pop. Of course he did not have any of the type of dressing that I wanted him to use. I told him to just carefully cover the wound itself, avoiding the blister as best he could and then get to my house as soon as he was able so that I could put a more substantial dressing on it prior to his appointment that afternoon.
When he arrived at my house about an hour later I looked at his leg and saw that he had a weird shaped blister, more like one large one and then a small one directly next to it. The smaller one appeared to have ruptured but the big one was still intact and the primary wound did seem to be doing very well. I then loosely covered the entire “situation” with 4x4 gauze, knowing that it would be sufficient until his appointment a couple hours later.
When we got to the wound care center we told the nurse that the wound had been doing well until that morning when a blood blister was discovered. The nurse uncovered the wound and told us that the doctor would be in soon. We waited and when the doctor came into the room we explained what was going on and my boyfriend’s thoughts on what caused the blister in the first place.
The surgeon then said that he was going to test the fluid in the blister to make sure that it wasn’t showing any bacteria that would need to be treated. He poked a tiny hole in the blister with a small needle and aspirated some of the fluid. He then said that the wound should continue to be treated the same way we had been, with the Bactroban ointment and just a small piece of gauze to cover. He said that if the culture came back showing anything that needed to be treated he would call to let us know but that he wanted to see him again in two weeks.
My boyfriend took care of his wound for himself for almost the entire two weeks and kept telling me that he thought it looked like it was doing well. I was happy to hear that he thought it was fine, but I was also a little bit nervous that he would minimize it if things weren’t going well. I hoped though that he was aware of just how quickly things like this can go downhill and would at the very least tell me if it began to change. Two days before his appointment at the wound care center I asked if I could please see another picture, so that I could reassure myself that he really was “fine”. My boyfriend sent me the picture he had taken that morning and I was disturbed by what I saw. When I had last seen it in person, I noticed that the blister appeared to be flattened out and was looking more callous than blister. The picture he sent me showed even more of the dark calloused area. Admittedly, I flipped out when I saw the picture. In hindsight, I realize that most of my reaction was caused by not being able to clearly see what was going on. My boyfriend tried to explain to me that it “wasn’t that bad” and that it was only the blister that looked “kind of gross”. I wanted no part of his explanation and shut down the conversation. Not the best idea in that situation, but being that nothing could be done about his wound at that point, it was really not worth it to discuss it anymore.
A couple of days later we went to his appointment at the wound care center and I explained to the nurse that I personally hadn’t seen it in a few days but that I did not feel comfortable with how it looked. The nurse took the dressing off and said that the blister had flattened out and was now a callous. I took the opportunity to look at the wound in person for the first time since I had flipped out about the picture I had seen. When I saw the wound I was happy to see that it was not nearly as bad as it had appeared in the picture. When the nurse left I told my boyfriend that it was not as bad as I originally thought, but that it still, “wasn’t pretty”. A few minutes later the surgeon walked into the room and when he looked at the wound a really funny look appeared on his face. His face seemed to say, “What the hell happened, what do you want me to do about that and how am I supposed to work with that” all rolled into one facial expression. He then asked when it had become calloused and I stopped laughing so that I could tell him that it had begun about five days prior. The doctor then began to scrape away the calloused area and when he did he was pleased with how it looked underneath. He said that he was also really happy with how the primary wound looked. The doctor told us to continue treating it the same way we had been and that he wanted to see the wound in a week. My boyfriend and I left the appointment happy with how things were going and admittedly I personally, was still somewhat giggly because I still had the look of the doctor’s face in my head.
His wound was doing incredibly well; it was appearing much smaller and had no signs of infection. Just as I was beginning to relax, he threw me a curve ball. He sent me a text message two weeks ago on the day that he had an appointment at the wound care center. He told me that when he woke up, he discovered a blood blister directly above the wound and asked me what he should do to cover it because he was worried that the dressings he was using would cause it to pop. At first I thought he was just messing with my head and trying to get a reaction out of me by claiming to have a blood blister so I told him to prove it. Minutes later I received a picture of what in fact was a blood blister.
I took a breath and picked up the phone and called him. I asked what size dressings he had, hoping against hope that he had one that would be big enough and loose enough to cover the entire wound, including the blood blister, without being so tight that it would pop. Of course he did not have any of the type of dressing that I wanted him to use. I told him to just carefully cover the wound itself, avoiding the blister as best he could and then get to my house as soon as he was able so that I could put a more substantial dressing on it prior to his appointment that afternoon.
When he arrived at my house about an hour later I looked at his leg and saw that he had a weird shaped blister, more like one large one and then a small one directly next to it. The smaller one appeared to have ruptured but the big one was still intact and the primary wound did seem to be doing very well. I then loosely covered the entire “situation” with 4x4 gauze, knowing that it would be sufficient until his appointment a couple hours later.
When we got to the wound care center we told the nurse that the wound had been doing well until that morning when a blood blister was discovered. The nurse uncovered the wound and told us that the doctor would be in soon. We waited and when the doctor came into the room we explained what was going on and my boyfriend’s thoughts on what caused the blister in the first place.
The surgeon then said that he was going to test the fluid in the blister to make sure that it wasn’t showing any bacteria that would need to be treated. He poked a tiny hole in the blister with a small needle and aspirated some of the fluid. He then said that the wound should continue to be treated the same way we had been, with the Bactroban ointment and just a small piece of gauze to cover. He said that if the culture came back showing anything that needed to be treated he would call to let us know but that he wanted to see him again in two weeks.
My boyfriend took care of his wound for himself for almost the entire two weeks and kept telling me that he thought it looked like it was doing well. I was happy to hear that he thought it was fine, but I was also a little bit nervous that he would minimize it if things weren’t going well. I hoped though that he was aware of just how quickly things like this can go downhill and would at the very least tell me if it began to change. Two days before his appointment at the wound care center I asked if I could please see another picture, so that I could reassure myself that he really was “fine”. My boyfriend sent me the picture he had taken that morning and I was disturbed by what I saw. When I had last seen it in person, I noticed that the blister appeared to be flattened out and was looking more callous than blister. The picture he sent me showed even more of the dark calloused area. Admittedly, I flipped out when I saw the picture. In hindsight, I realize that most of my reaction was caused by not being able to clearly see what was going on. My boyfriend tried to explain to me that it “wasn’t that bad” and that it was only the blister that looked “kind of gross”. I wanted no part of his explanation and shut down the conversation. Not the best idea in that situation, but being that nothing could be done about his wound at that point, it was really not worth it to discuss it anymore.
A couple of days later we went to his appointment at the wound care center and I explained to the nurse that I personally hadn’t seen it in a few days but that I did not feel comfortable with how it looked. The nurse took the dressing off and said that the blister had flattened out and was now a callous. I took the opportunity to look at the wound in person for the first time since I had flipped out about the picture I had seen. When I saw the wound I was happy to see that it was not nearly as bad as it had appeared in the picture. When the nurse left I told my boyfriend that it was not as bad as I originally thought, but that it still, “wasn’t pretty”. A few minutes later the surgeon walked into the room and when he looked at the wound a really funny look appeared on his face. His face seemed to say, “What the hell happened, what do you want me to do about that and how am I supposed to work with that” all rolled into one facial expression. He then asked when it had become calloused and I stopped laughing so that I could tell him that it had begun about five days prior. The doctor then began to scrape away the calloused area and when he did he was pleased with how it looked underneath. He said that he was also really happy with how the primary wound looked. The doctor told us to continue treating it the same way we had been and that he wanted to see the wound in a week. My boyfriend and I left the appointment happy with how things were going and admittedly I personally, was still somewhat giggly because I still had the look of the doctor’s face in my head.
Wednesday, February 13, 2013
Learning to Relax (in more ways than one)
It has now been approximately three weeks since I have been discharged from the Wound Care Center. My visiting nurses are still seeing me once a week and they are confident that my wound is really closed for good this time. Their confidence is great; I am just waiting for my mind to catch up to it. I am still incredibly nervous that it may open again. I am trying to strike a balance between being aware that the wound has opened in the past, yet trying to adjust to having my life back to normal. I still regularly make sure that I’m not seeing any discharge and also, asking my boyfriend to check to make sure that it is closed between nursing visits. When my nurse came yesterday she assured me that it is closed and then warned me that the next visit may end up being my last. Apparently when she told me that I had a terrified look on my face because she immediately said that she really does only live a couple of minutes away and that it was okay for me to call her if I really felt that something was weird after I was discharged. She said that she would either come out to check the wound if I was really upset or if I was just mildly concerned she said she might just try to talk to me and try to get me to calm down.
My boyfriend has said that it is okay with him if I post a few of the pictures, so though I chose to keep my wound pictures private, I will share his.
Boyfriend's wound picture taken approximately September 4, 2012
After the visiting nurse and I treated it for a few weeks, it began to look too dry:
Picture taken October 16, 2012
Picture taken mid October, after treating with Hydrogel
Picture taken late October 2012
Picture taken early November 2012
Everything after that seemed fine until I saw it again in late January 2013. That is when I told him that it needed to be seen.
What my boyfriend's wound looked like in mid/late January
Photo from the first time the wound care center saw the wound (January 30, 2013) after it had been treated with Calcium alginate and a Tegaderm Foam Adhesive
Taken at wound care February 6, 2013 after having daily ABD dressing changes
Photo taken approximately February 8,2013 after Bactroban ointment
Taken February 9, 2013 after continued Bactroban
Calm down seems to be a recurring theme in my wound-life because when my boyfriend left to go to his house last week I was a little bit worried that he would have to take care of his wound without me. I was confident that he is not incompetent and could change the dressings without a problem, but I was worried that he would minimize it if he suddenly weren’t doing as well. That paranoia lead to me regularly asking him to text me pictures of his wound so that I could stay as up to date on its progress as possible. I am getting ahead of myself though, last week at my boyfriend’s appointment at the wound care center he was told that the culture results had come back positive for MRSA.
The surgeon therefore prescribed Bactroban Ointment an antibiotic to treat the infection, which my boyfriend was to apply to the wound bed once or twice a day when he changed the dressing. When the surgeon examined the wound itself though, he said that he thought it appeared a little smaller. I concurred (as if my opinion actually matters. ha-ha) that it did seem to be a little better than it had been, at least since the last time I had seen it.
My boyfriend is continuing to treat his wound himself at home and is periodically updating me on what he thinks is happening. He goes back to the wound care center next week. The surgeon said the he had a feeling that treating it with the ointment and just a small gauze pad would get it going in the direction we wanted it to go in. Hopefully, the surgeon is correct. Currently I am waiting for my boyfriend to visit so that among other things, he can show me a picture of my wound again so that maybe we can drill it into my head that it really is closed.
I know I am bordering on ridiculous with my level of paranoia about my wound; it is just that I cannot get the previous time that it was closed out of my head. I was so incredibly happy and relieved that it had closed (after 3+ years) and then absolutely devastated when it opened after six weeks of it being closed and living a normal life, once again doing what I wanted to do without having to worry about a wound.
My boyfriend has said that it is okay with him if I post a few of the pictures, so though I chose to keep my wound pictures private, I will share his.
Boyfriend's wound picture taken approximately September 4, 2012
After the visiting nurse and I treated it for a few weeks, it began to look too dry:
Picture taken October 16, 2012
Picture taken mid October, after treating with Hydrogel
Picture taken late October 2012
Picture taken early November 2012
Everything after that seemed fine until I saw it again in late January 2013. That is when I told him that it needed to be seen.
What my boyfriend's wound looked like in mid/late January
Photo from the first time the wound care center saw the wound (January 30, 2013) after it had been treated with Calcium alginate and a Tegaderm Foam Adhesive
Taken at wound care February 6, 2013 after having daily ABD dressing changes
Photo taken approximately February 8,2013 after Bactroban ointment
Taken February 9, 2013 after continued Bactroban
Calm down seems to be a recurring theme in my wound-life because when my boyfriend left to go to his house last week I was a little bit worried that he would have to take care of his wound without me. I was confident that he is not incompetent and could change the dressings without a problem, but I was worried that he would minimize it if he suddenly weren’t doing as well. That paranoia lead to me regularly asking him to text me pictures of his wound so that I could stay as up to date on its progress as possible. I am getting ahead of myself though, last week at my boyfriend’s appointment at the wound care center he was told that the culture results had come back positive for MRSA.
The surgeon therefore prescribed Bactroban Ointment an antibiotic to treat the infection, which my boyfriend was to apply to the wound bed once or twice a day when he changed the dressing. When the surgeon examined the wound itself though, he said that he thought it appeared a little smaller. I concurred (as if my opinion actually matters. ha-ha) that it did seem to be a little better than it had been, at least since the last time I had seen it.
My boyfriend is continuing to treat his wound himself at home and is periodically updating me on what he thinks is happening. He goes back to the wound care center next week. The surgeon said the he had a feeling that treating it with the ointment and just a small gauze pad would get it going in the direction we wanted it to go in. Hopefully, the surgeon is correct. Currently I am waiting for my boyfriend to visit so that among other things, he can show me a picture of my wound again so that maybe we can drill it into my head that it really is closed.
I know I am bordering on ridiculous with my level of paranoia about my wound; it is just that I cannot get the previous time that it was closed out of my head. I was so incredibly happy and relieved that it had closed (after 3+ years) and then absolutely devastated when it opened after six weeks of it being closed and living a normal life, once again doing what I wanted to do without having to worry about a wound.
Saturday, February 2, 2013
A Different Side of Wound Care
I had a visiting nurse the next day and told her that I was nervous that my wound had possibly opened again but that I was getting mixed signals from my body. When the nurse looked she said that it was still closed and that I should try to calm down, while still paying attention to what my body was telling me. I was happy to learn that it was still closed but was confused by where the drainage had come from. My nurse looked around the entire area of my wound and said that she did not see anything that looked like it had opened or bled. I was relieved that it still appeared to be closed. That is when my nurse told me that either she or my other nurse would see me a week later. Already they were starting the discharge process, which begins with them only seeing me once a week for several weeks. They do this so that we can be sure that the wound is fully closed and seems to be staying closed. I knew how this process was, based on what had occurred several months earlier and I was comfortable with the process, I just did not think that it was going to start so soon. I expressed to my nurse that I was nervous that no one was going to see it for an entire week and she assured me that everything looked fine and also said that she was really only a phone call away if I really felt that things were going wrong. Before she left she asked how my boyfriend was doing and verified that he was going to be seen at the wound care center within a few days.
The next day when my boyfriend came to my house he said that he had to listen to a voicemail because he had missed a call from the wound care center while he was driving to my house. He only listened to part of the message and then told me that he had to call to reschedule for later in the day. I asked to listen to the message and when I heard it I realized that he wasn’t being asked to reschedule for later in the day, but for the following week at a completely different time. I told him that that was what I understood it to be and though I was displeased, I knew he was the patient and so these decisions were his to make. Before he returned their call I told him that to me it did not sound like they were making the connection that we were together and that he should use my name, or at least tell them that I said hello so that maybe something would click in their heads. My boyfriend chose not to use my name or really do a whole lot of advocating for himself so that he would be able to be seen. I sort of overheard the conversation and was peeved that he didn’t say anything about being with me, because it sure did not sound like the wound care center realized it.
When my boyfriend got off the phone I asked him when it was rescheduled for and when he told me I was then even more positive that they did not know we were together just based on the day and time his appointment was made for. I told him that I was pretty sure he was going to get a different doctor than he was originally scheduled to see, my boyfriend disagreed but we both dropped the subject.
The next day was when my boyfriend’s appointment was supposed to have been and I needed to go to the surgeon’s office to speak to people about a different matter. When I was getting out of the car my boyfriend asked me if I could ask the office manager if she had any idea if the surgeon was going to be at the wound care center during the time his appointment had been rescheduled for. I agreed to ask, happy that he was possibly beginning to realize that things were maybe not as he first thought they were.
When I got into the office I was surprised to see my surgeon! I have been in his office quite a bit for reasons and I have never seen him there. When he noticed me he asked what I was doing there and then questioned what had happened with my boyfriend’s appointment. I explained the situation and then asked him if the rescheduled appointment was even going to be with him, he said that it was not. The surgeon then asked if my boyfriend needed to be seen that day and asked if waiting if he was running late would be okay. I said that yes he should be seen and that waiting was not a problem at all. The surgeon then, worked his magic and the appointment was made for a couple of hours later that afternoon. When I left the office and told my boyfriend, he was very happy that it had all gotten worked out.
A couple of hours later when we were about to go into the wound care center I asked my boyfriend if he wanted me to go in with him or if he would prefer if I waited in the waiting room. My boyfriend said that yes he wanted me to go in the appointment with him. While we were waiting in the exam room for the nurse to come in, I asked my boyfriend if he wanted me to do any of the talking or if he wanted me to be a silent observer. He said that I could do some of the talking. When the nurse came into the exam room she did the typical things that happen at a first appointment. My boyfriend and I explained to her how it had recently been treated and then we waited for the surgeon to come in. Admittedly, I was sort of amused by this point; I was not the patient, finally! I also sort of made a joke to the nurse that I was interested to see the surgeon actually do something because based on the location of my wound I had never actually seen him do anything.
When the surgeon came in he examined the wound and asked my boyfriend how he thought he had gotten it in the first place. The surgeon decided that he was going to culture it and also to biopsy it so that we would know if anything really funky was going on inside. The surgeon also said that he wanted my boyfriend to get his leg x-rayed before we left. All of that sounded like a good plan so the surgeon took a small tissue sample. When he took the sample, the wound began to bleed, I watched it but was not alarmed because I knew that good blood flow was a good sign for wound healing. The surgeon then cauterized it so that the bleeding would stop and told the nurse what type of dressing to put on it. He then told my boyfriend he would see him the following week but would call him sooner if the lab results showed anything that he would need to know sooner.
The nurse then came over and explained to both of us the type of dressing that she was putting on it and how often it would need to be changed. My boyfriend was not going to need visiting nurses so it was going to be up to him and to a lesser extent myself to change the dressings and monitor the wound. She was going to put a type of Hydrocolloid dressing on it and said that we should change it every three to five days and more often if the amount of drainage required it. The nurse then looked at the wound and realized that it had begun to bleed again. She held pressure to it and it slowed down, she then said she was going to place a small piece of calcium alginate just over the part that was bleeding, She then placed the Hydrocolloid dressing on top and while looking at the amount of drainage explained that that dressing would need to be changed sooner than in a few days. We left the wound care center certain that we were capable of handling it.
A couple of hours after we got back to my house we decided that the dressing should be changed. I took off the dressing and noticed that it was still bleeding from that one area but only a small trickle. I did not think much of it and so I just put a small piece of calcium alginate over that area and then put the dressing in place. Everything seemed to be going well until just before my boyfriend was about to leave, that is when we realized that a small circle of blood was on the floor. My boyfriend came over to where I was and showed me his leg so that we could determine how to proceed. When I saw that the dressing was saturated with blood and that it was coming out of all the sides I knew instantly that it needed to be changed. When I took off the dressing I was rather appalled by the amount of blood that I saw. The dressing that had been prescribed does not absorb exudate as much as it turns it into a gel. The bloody gel was sitting on top of the wound, I knew that it had to be removed so that I could both change the piece of calcium alginate and examine the area that was bleeding. I took a deep breath as I was putting on a pair of gloves and then carefully grabbed the gel like substance from the wound to dispose of it. After I did that I looked at the part that the blood was coming from and noticed that it was actually bleeding this time and not with just a trickle.
My brain clicked on almost immediately and I shoved a bunch of pillows under my boyfriend’s leg, hoping that the blood would stop if it were elevated. I also held pressure to the wound knowing that the combination of elevation and pressure usually makes bleeding stop. This had gone on for quite awhile and although I did not want to bother the surgeon I knew I was in over my head, so I sent him a text message explaining that it was still actively bleeding and that my boyfriend would only have one dressing left to last the entire week after I redressed it. The surgeon clarified which dressing he had prescribed. I answered his question and then explained that I had changed it once already but that this time the bleeding was worse. The surgeon then told me to use calcium alginate and then instructed me on how to properly apply direct pressure to get the bleeding to stop. I explained that yes we had calcium alginate and that we had used it before also. The surgeon told me, “no worries. It will stop”. The bleeding eventually slowed down considerably but did not seem to stop. When the surgeon sent me a message about an hour later asking if everything was okay, I explained that it had slowed down but never stopped but that a few minutes before his messaged me it had started to actively bleed again and asked him what he thought we should do. I explained that I had applied the dressing and it was saturated. While I waited for him to respond I called and left a message at the wound care center explaining that we were rapidly running out of dressings and questioned if we would be able to pick some up the following morning and to please call me.
Meanwhile we were now at the wee-hours of the morning and my boyfriend had fallen asleep! I was tending to his bloody mess while he lay on the bed snoring. I was not exactly happy with him at that moment but I didn’t really mind it all that much because there was really no logical reasons for the two of us to be awake the entire night. I eventually couldn’t help myself and fell asleep. I slept for about two hours and then woke up. About an hour after I woke up the surgeon replied to my text message and told me that I should wrap it with an Ace bandage over top of the saturated dressing. I woke up my boyfriend and asked him to get an Ace bandage so that I could follow the surgeon’s instructions. Shortly after I applied the Ace wrap I received a phone call from one of the nurses at the wound care center. I explained everything that had gone on the day before and through the night. The nurse said that she was going to get in touch with the surgeon and would call me back shortly. When she called back she explained that she would be at the wound care center for a few hours and that we could come in if we wanted.
We decided that we were going to go to the wound care center to get the wound looked at and also to pick up enough dressings to last the six remaining days until his next appointment. The nurse unwrapped the wound and we saw that it was bleeding the nurse then said that she was going to cauterize it. I explained that the surgeon had done that the previous day and it still bled. The nurse questioned that he had because he had told her that she should cauterize it when she saw it. I said that yes I was pretty sure he had, the nurse then said that she was still going to do it. When she did that the blood seemed to stop, finally! She then asked me what types of dressings I had in my arsenal at home and I named a couple. She then said that she was going to switch him to an Abdominal Pad Dressing (ABD Dressing) and was then going to apply an Ace wrap tightly on top of that. She told us that that needed to be changed on a daily basis and reminded us that she would be at the wound care center the following day if we needed her for anything. We left the wound care center glad that we had made the decision to get the wound looked at and hopeful that we wouldn’t have anymore drama before the next appointment.
The next day when my boyfriend came to my house he said that he had to listen to a voicemail because he had missed a call from the wound care center while he was driving to my house. He only listened to part of the message and then told me that he had to call to reschedule for later in the day. I asked to listen to the message and when I heard it I realized that he wasn’t being asked to reschedule for later in the day, but for the following week at a completely different time. I told him that that was what I understood it to be and though I was displeased, I knew he was the patient and so these decisions were his to make. Before he returned their call I told him that to me it did not sound like they were making the connection that we were together and that he should use my name, or at least tell them that I said hello so that maybe something would click in their heads. My boyfriend chose not to use my name or really do a whole lot of advocating for himself so that he would be able to be seen. I sort of overheard the conversation and was peeved that he didn’t say anything about being with me, because it sure did not sound like the wound care center realized it.
When my boyfriend got off the phone I asked him when it was rescheduled for and when he told me I was then even more positive that they did not know we were together just based on the day and time his appointment was made for. I told him that I was pretty sure he was going to get a different doctor than he was originally scheduled to see, my boyfriend disagreed but we both dropped the subject.
The next day was when my boyfriend’s appointment was supposed to have been and I needed to go to the surgeon’s office to speak to people about a different matter. When I was getting out of the car my boyfriend asked me if I could ask the office manager if she had any idea if the surgeon was going to be at the wound care center during the time his appointment had been rescheduled for. I agreed to ask, happy that he was possibly beginning to realize that things were maybe not as he first thought they were.
When I got into the office I was surprised to see my surgeon! I have been in his office quite a bit for reasons and I have never seen him there. When he noticed me he asked what I was doing there and then questioned what had happened with my boyfriend’s appointment. I explained the situation and then asked him if the rescheduled appointment was even going to be with him, he said that it was not. The surgeon then asked if my boyfriend needed to be seen that day and asked if waiting if he was running late would be okay. I said that yes he should be seen and that waiting was not a problem at all. The surgeon then, worked his magic and the appointment was made for a couple of hours later that afternoon. When I left the office and told my boyfriend, he was very happy that it had all gotten worked out.
A couple of hours later when we were about to go into the wound care center I asked my boyfriend if he wanted me to go in with him or if he would prefer if I waited in the waiting room. My boyfriend said that yes he wanted me to go in the appointment with him. While we were waiting in the exam room for the nurse to come in, I asked my boyfriend if he wanted me to do any of the talking or if he wanted me to be a silent observer. He said that I could do some of the talking. When the nurse came into the exam room she did the typical things that happen at a first appointment. My boyfriend and I explained to her how it had recently been treated and then we waited for the surgeon to come in. Admittedly, I was sort of amused by this point; I was not the patient, finally! I also sort of made a joke to the nurse that I was interested to see the surgeon actually do something because based on the location of my wound I had never actually seen him do anything.
When the surgeon came in he examined the wound and asked my boyfriend how he thought he had gotten it in the first place. The surgeon decided that he was going to culture it and also to biopsy it so that we would know if anything really funky was going on inside. The surgeon also said that he wanted my boyfriend to get his leg x-rayed before we left. All of that sounded like a good plan so the surgeon took a small tissue sample. When he took the sample, the wound began to bleed, I watched it but was not alarmed because I knew that good blood flow was a good sign for wound healing. The surgeon then cauterized it so that the bleeding would stop and told the nurse what type of dressing to put on it. He then told my boyfriend he would see him the following week but would call him sooner if the lab results showed anything that he would need to know sooner.
The nurse then came over and explained to both of us the type of dressing that she was putting on it and how often it would need to be changed. My boyfriend was not going to need visiting nurses so it was going to be up to him and to a lesser extent myself to change the dressings and monitor the wound. She was going to put a type of Hydrocolloid dressing on it and said that we should change it every three to five days and more often if the amount of drainage required it. The nurse then looked at the wound and realized that it had begun to bleed again. She held pressure to it and it slowed down, she then said she was going to place a small piece of calcium alginate just over the part that was bleeding, She then placed the Hydrocolloid dressing on top and while looking at the amount of drainage explained that that dressing would need to be changed sooner than in a few days. We left the wound care center certain that we were capable of handling it.
A couple of hours after we got back to my house we decided that the dressing should be changed. I took off the dressing and noticed that it was still bleeding from that one area but only a small trickle. I did not think much of it and so I just put a small piece of calcium alginate over that area and then put the dressing in place. Everything seemed to be going well until just before my boyfriend was about to leave, that is when we realized that a small circle of blood was on the floor. My boyfriend came over to where I was and showed me his leg so that we could determine how to proceed. When I saw that the dressing was saturated with blood and that it was coming out of all the sides I knew instantly that it needed to be changed. When I took off the dressing I was rather appalled by the amount of blood that I saw. The dressing that had been prescribed does not absorb exudate as much as it turns it into a gel. The bloody gel was sitting on top of the wound, I knew that it had to be removed so that I could both change the piece of calcium alginate and examine the area that was bleeding. I took a deep breath as I was putting on a pair of gloves and then carefully grabbed the gel like substance from the wound to dispose of it. After I did that I looked at the part that the blood was coming from and noticed that it was actually bleeding this time and not with just a trickle.
My brain clicked on almost immediately and I shoved a bunch of pillows under my boyfriend’s leg, hoping that the blood would stop if it were elevated. I also held pressure to the wound knowing that the combination of elevation and pressure usually makes bleeding stop. This had gone on for quite awhile and although I did not want to bother the surgeon I knew I was in over my head, so I sent him a text message explaining that it was still actively bleeding and that my boyfriend would only have one dressing left to last the entire week after I redressed it. The surgeon clarified which dressing he had prescribed. I answered his question and then explained that I had changed it once already but that this time the bleeding was worse. The surgeon then told me to use calcium alginate and then instructed me on how to properly apply direct pressure to get the bleeding to stop. I explained that yes we had calcium alginate and that we had used it before also. The surgeon told me, “no worries. It will stop”. The bleeding eventually slowed down considerably but did not seem to stop. When the surgeon sent me a message about an hour later asking if everything was okay, I explained that it had slowed down but never stopped but that a few minutes before his messaged me it had started to actively bleed again and asked him what he thought we should do. I explained that I had applied the dressing and it was saturated. While I waited for him to respond I called and left a message at the wound care center explaining that we were rapidly running out of dressings and questioned if we would be able to pick some up the following morning and to please call me.
Meanwhile we were now at the wee-hours of the morning and my boyfriend had fallen asleep! I was tending to his bloody mess while he lay on the bed snoring. I was not exactly happy with him at that moment but I didn’t really mind it all that much because there was really no logical reasons for the two of us to be awake the entire night. I eventually couldn’t help myself and fell asleep. I slept for about two hours and then woke up. About an hour after I woke up the surgeon replied to my text message and told me that I should wrap it with an Ace bandage over top of the saturated dressing. I woke up my boyfriend and asked him to get an Ace bandage so that I could follow the surgeon’s instructions. Shortly after I applied the Ace wrap I received a phone call from one of the nurses at the wound care center. I explained everything that had gone on the day before and through the night. The nurse said that she was going to get in touch with the surgeon and would call me back shortly. When she called back she explained that she would be at the wound care center for a few hours and that we could come in if we wanted.
We decided that we were going to go to the wound care center to get the wound looked at and also to pick up enough dressings to last the six remaining days until his next appointment. The nurse unwrapped the wound and we saw that it was bleeding the nurse then said that she was going to cauterize it. I explained that the surgeon had done that the previous day and it still bled. The nurse questioned that he had because he had told her that she should cauterize it when she saw it. I said that yes I was pretty sure he had, the nurse then said that she was still going to do it. When she did that the blood seemed to stop, finally! She then asked me what types of dressings I had in my arsenal at home and I named a couple. She then said that she was going to switch him to an Abdominal Pad Dressing (ABD Dressing) and was then going to apply an Ace wrap tightly on top of that. She told us that that needed to be changed on a daily basis and reminded us that she would be at the wound care center the following day if we needed her for anything. We left the wound care center glad that we had made the decision to get the wound looked at and hopeful that we wouldn’t have anymore drama before the next appointment.
Sunday, January 27, 2013
Uncertainty
“My one purpose in writing is simply to provide a catharsis for my own thoughts. They worry me until they are set forth in words.” ---
H.L. Mencken
I usually only turn to this blog after I have the facts from my surgeon or one of my nurses. Today, however, is going to be a bit different. I have been going through a lot surrounding my wound and so today please allow me to use this to express my frustrations, fears, worry and joys.
Last week I had an appointment with my surgeon at the wound care center. Being that the previous week my surgeon had proclaimed my wound healed and my visiting nurses also seemed to agree I went into the appointment kind of feeling like I was going to be discharged, yet still sort of unsure about the situation. As a matter of fact, when I went in the nurse asked me if we had “sealed the deal”, in other words if my wound was closed. I told her that I thought so, I also told her about the communication that my nurse had received that caused me to be so incredibly cautiously optimistic the week before. The nurse understood why I had felt confused and when I told her the depth that was mentioned in the communication she told me that she was virtually positive that it was in fact an outdated communication, which I shouldn’t worry about.
When my surgeon came in and examined my wound he also said that it was closed and I was done, I was marginally more excited than I had been the previous week but was not anywhere near feeling the joy I felt the first time my surgeon had discharged me. Before I left the nurse and surgeon took a picture of my wound to document that it was healed and also to show me what it looked like. I never got to actually see that picture though because we got talking about another pressing topic that was taking over my life.
Several months ago I discovered that my boyfriend had a wound on his lower leg. He being a typical guy minimized it and was not at all concerned. I was worried though so I tried to encourage him to get it checked out if not by a doctor, at least by my visiting nurse. He refused and because I did not want to nag him I let the subject drop but only temporarily. Eventually, he agreed to let my visiting nurse take a look at it, he said it was because I was genuinely concerned but I personally think he just wanted me off his case. My visiting nurse, with me also being her eyes was sort of treating his wound off the record for a couple of months and then it healed.
Unfortunately, his wound did not stay closed. My boyfriend asked me if my visiting nurse would be able to take a look at it again, because this time it was draining. My boyfriend’s schedule however, did not mesh with when she was coming over so last week when he was with me; I offered to look at it. He allowed me to do that and once I did, I almost immediately said that it needed to be seen. I also recovered the wound, using calcium alginate to absorb some of the drainage and then covered that with a Tegaderm foam adhesive dressing. I then asked my boyfriend if he wanted me to call the wound care center to ask if he could be seen, ideally while we were both there later that day for my appointment. They were unable to fit him in that day but could schedule him for a week later.
All of this was on my mind during my appointment, so some of the time we were talking about my boyfriend’s wound and what I had done after I had seen it that morning. I explained what I had seen and then how I had covered it again. The nurse seemed to think that what I had done sounded like the right thing to do until the surgeon could see it. I then halfway jokingly asked her if she would kindly get some of this information out of my head, that I could not stop thinking. She chuckled and said no.
My boyfriend and I left the wound care center and as we were leaving I told him that I had been discharged but that this time I was really not going to tell anyone other then him at least until my wound stayed closed for awhile. I had decided this because I will never forget the shattered look on my parents’ faces when I had to tell them that it had reopened after seven weeks of being fine. When we got to my house I asked my boyfriend if he would take a picture so that I could see being that I never got around to seeing the one from the wound care center. I saw the picture and although I was still only cautiously optimistic I was happy to see it closed. A few hours later my visiting nurse returned my phone call and I told her that my surgeon said I was done but that they couldn’t get rid of me that easily because I was going to go back the next week with my boyfriend. My nurse was thrilled to hear about me but was disappointed to hear that my boyfriend’s wound had opened up again. She then told me that getting it seen was a good idea, not so much because of the drainage but because their could be an underlying cause of the wound. That was precisely my thinking also.
Two days later my visiting nurse came to my house and she was so incredibly happy to hear that my wound had closed that as soon as she walked into my room she turned on the music that was on her iPhone. She had decided that this visit was going to be a fun one. I was okay with that but also told her that I am trying to temper my joy with some realistic expectations, purely because I had become so devastated when it had opened. When she looked at the wound she also said that it was closed and then took a picture so that I could see it. The picture that she showed me was different from the one my boyfriend had taken just two days earlier. I calmly asked her what the darker part was and that it looked open to me. She said that a tiny part of it was open but that it had absolutely no depth at all and was not draining so she was still calling it healed and even decided not to cover it. When she left my brain started spinning. I was upset that it looked different in just two days and had no idea what to think about her not covering it again.
I did not have any drainage that I noticed for the rest of that day so I was sort of hoping that my nurse was right and that I was needlessly being paranoid. I spent the majority of the day in bed, this time because I had come down with a cold.
The day after that was when I began to get a really weird feeling that my wound had opened even more and was potentially draining again. I did not feel anything at that point so I tried to convince myself that my mind was playing tricks on me and that I needed to relax, especially because my cold was really making me feel crummy. I lounged in bed and when I wasn’t sleeping I was trying to zone out to the television. The thing that did pop into my head periodically was my boyfriend’s wound. His appointment at the wound care center was four days away and I was interested to know what it was going to be like to be on the other side of a wound care situation. That evening when I got out of bed I noticed something that may have been drainage coming from my wound, I was a little nervous but did not do anything about it. Again, my mind had been playing tricks on me and I was trying to convince myself that while I had the right to be concerned after all I had been through, I should also try to think positively.
Thinking positively is apparently not something I am very good at doing though, especially when I am stressed. That night, while having dinner my mother said something really funny and I started laughing so hard that my eyes started watering. Once that happened though the tears brought on by laughter turned to tears of stress due to being unsure about my wound and being concerned about my boyfriend’s wound. Of course my parents have no idea that any of this is going on so I was crying with a goofy grin on my face. It wasn’t that big of a deal but it did make me feel like a fool. Here I was having dinner with my parents; one minute laughing at my mother and the next minute crying about the uncertainty that was happening in my life. I am pretty sure that I will have a visiting nurse at some point tomorrow who will hopefully be able to tell me if what I noticed was actually drainage or if I really do just need to calm down.
H.L. Mencken
I usually only turn to this blog after I have the facts from my surgeon or one of my nurses. Today, however, is going to be a bit different. I have been going through a lot surrounding my wound and so today please allow me to use this to express my frustrations, fears, worry and joys.
Last week I had an appointment with my surgeon at the wound care center. Being that the previous week my surgeon had proclaimed my wound healed and my visiting nurses also seemed to agree I went into the appointment kind of feeling like I was going to be discharged, yet still sort of unsure about the situation. As a matter of fact, when I went in the nurse asked me if we had “sealed the deal”, in other words if my wound was closed. I told her that I thought so, I also told her about the communication that my nurse had received that caused me to be so incredibly cautiously optimistic the week before. The nurse understood why I had felt confused and when I told her the depth that was mentioned in the communication she told me that she was virtually positive that it was in fact an outdated communication, which I shouldn’t worry about.
When my surgeon came in and examined my wound he also said that it was closed and I was done, I was marginally more excited than I had been the previous week but was not anywhere near feeling the joy I felt the first time my surgeon had discharged me. Before I left the nurse and surgeon took a picture of my wound to document that it was healed and also to show me what it looked like. I never got to actually see that picture though because we got talking about another pressing topic that was taking over my life.
Several months ago I discovered that my boyfriend had a wound on his lower leg. He being a typical guy minimized it and was not at all concerned. I was worried though so I tried to encourage him to get it checked out if not by a doctor, at least by my visiting nurse. He refused and because I did not want to nag him I let the subject drop but only temporarily. Eventually, he agreed to let my visiting nurse take a look at it, he said it was because I was genuinely concerned but I personally think he just wanted me off his case. My visiting nurse, with me also being her eyes was sort of treating his wound off the record for a couple of months and then it healed.
Unfortunately, his wound did not stay closed. My boyfriend asked me if my visiting nurse would be able to take a look at it again, because this time it was draining. My boyfriend’s schedule however, did not mesh with when she was coming over so last week when he was with me; I offered to look at it. He allowed me to do that and once I did, I almost immediately said that it needed to be seen. I also recovered the wound, using calcium alginate to absorb some of the drainage and then covered that with a Tegaderm foam adhesive dressing. I then asked my boyfriend if he wanted me to call the wound care center to ask if he could be seen, ideally while we were both there later that day for my appointment. They were unable to fit him in that day but could schedule him for a week later.
All of this was on my mind during my appointment, so some of the time we were talking about my boyfriend’s wound and what I had done after I had seen it that morning. I explained what I had seen and then how I had covered it again. The nurse seemed to think that what I had done sounded like the right thing to do until the surgeon could see it. I then halfway jokingly asked her if she would kindly get some of this information out of my head, that I could not stop thinking. She chuckled and said no.
My boyfriend and I left the wound care center and as we were leaving I told him that I had been discharged but that this time I was really not going to tell anyone other then him at least until my wound stayed closed for awhile. I had decided this because I will never forget the shattered look on my parents’ faces when I had to tell them that it had reopened after seven weeks of being fine. When we got to my house I asked my boyfriend if he would take a picture so that I could see being that I never got around to seeing the one from the wound care center. I saw the picture and although I was still only cautiously optimistic I was happy to see it closed. A few hours later my visiting nurse returned my phone call and I told her that my surgeon said I was done but that they couldn’t get rid of me that easily because I was going to go back the next week with my boyfriend. My nurse was thrilled to hear about me but was disappointed to hear that my boyfriend’s wound had opened up again. She then told me that getting it seen was a good idea, not so much because of the drainage but because their could be an underlying cause of the wound. That was precisely my thinking also.
Two days later my visiting nurse came to my house and she was so incredibly happy to hear that my wound had closed that as soon as she walked into my room she turned on the music that was on her iPhone. She had decided that this visit was going to be a fun one. I was okay with that but also told her that I am trying to temper my joy with some realistic expectations, purely because I had become so devastated when it had opened. When she looked at the wound she also said that it was closed and then took a picture so that I could see it. The picture that she showed me was different from the one my boyfriend had taken just two days earlier. I calmly asked her what the darker part was and that it looked open to me. She said that a tiny part of it was open but that it had absolutely no depth at all and was not draining so she was still calling it healed and even decided not to cover it. When she left my brain started spinning. I was upset that it looked different in just two days and had no idea what to think about her not covering it again.
I did not have any drainage that I noticed for the rest of that day so I was sort of hoping that my nurse was right and that I was needlessly being paranoid. I spent the majority of the day in bed, this time because I had come down with a cold.
The day after that was when I began to get a really weird feeling that my wound had opened even more and was potentially draining again. I did not feel anything at that point so I tried to convince myself that my mind was playing tricks on me and that I needed to relax, especially because my cold was really making me feel crummy. I lounged in bed and when I wasn’t sleeping I was trying to zone out to the television. The thing that did pop into my head periodically was my boyfriend’s wound. His appointment at the wound care center was four days away and I was interested to know what it was going to be like to be on the other side of a wound care situation. That evening when I got out of bed I noticed something that may have been drainage coming from my wound, I was a little nervous but did not do anything about it. Again, my mind had been playing tricks on me and I was trying to convince myself that while I had the right to be concerned after all I had been through, I should also try to think positively.
Thinking positively is apparently not something I am very good at doing though, especially when I am stressed. That night, while having dinner my mother said something really funny and I started laughing so hard that my eyes started watering. Once that happened though the tears brought on by laughter turned to tears of stress due to being unsure about my wound and being concerned about my boyfriend’s wound. Of course my parents have no idea that any of this is going on so I was crying with a goofy grin on my face. It wasn’t that big of a deal but it did make me feel like a fool. Here I was having dinner with my parents; one minute laughing at my mother and the next minute crying about the uncertainty that was happening in my life. I am pretty sure that I will have a visiting nurse at some point tomorrow who will hopefully be able to tell me if what I noticed was actually drainage or if I really do just need to calm down.
Tuesday, January 22, 2013
Cautious Optimism
I’m sorry that this post has been delayed so long. Things got a little absurd and I needed time to process before they came out in a jumbled mess of emotional chaos. I think I am at the point where I can write somewhat coherently so here we go.
My visiting nurses continued to fill the wound with collagen of one form or another for several weeks after the surgery. It seemed to me that the wound was progressing, slowly but still moving forward. During a visit to the wound care center my surgeon mentioned maybe wanting us to change what we were using, just to jumpstart the healing again. He thought that we should maybe switch back to using the Hydrofera Blue. That was when he asked about how much drainage we were noticing and I told him that it was still heavily draining. At that point my surgeon decided not to put in the Hydrofera Blue because he felt that it might just plug the drainage in the wound and not let it escape. I agreed and went home with instructions to continue using Collagen inside of the wound and the same Tegaderm foam dressing on top of it that we had been using.
The visiting nurses and I continued following my surgeon’s instructions and we were seeing some progress. I was happy to hear that things were going well but was still taking most of the good news with cautious optimism, with an emphasis on the cautious. In the beginning of December I went to my regular appointment at the wound care center and when my surgeon probed inside the wound to see what the depth was he was very happy. Actually, it was one of the few times when I had heard him really “up” about how it was doing. After I laughed about his reaction he told me to just keep doing what we were doing and to come back in two weeks so he could assess my wound again.
During the couple weeks I was waiting to go back to the wound care center my nurses started to become more and more pleased with my wound. The drainage was starting to decrease and the depth started to become less. The next time I saw my surgeon he was also pleased and told me to keep going with the collagen and see him again a few weeks later.
After about a week I mentioned to one of my visiting nurses that I had been thinking. Me thinking? Wait a minute; this could either be really good or really bad. See, as I have said wound care was continuing to take over my life and once in awhile I found myself unable to get wound care out of my head. I mentioned to her that my surgeon was at one point considering changing to Hydrofera Blue but he was concerned about having too much drainage. Based on the fact that we were noticing the drainage had decreased and had been on the collagen for approximately nine weeks I was thinking about mentioning to him that maybe that point would be a good time to switch what we were doing. My nurse agreed with my thinking and told me that it couldn’t hurt to bring it up with him at the following visit.
A couple of days later I had another visit from a nurse, this time it wasn’t the one that I was super comfortable with, but the one that I had been taking almost everything she said with a grain of salt. I mentioned my idea to her and she also told me that mentioning it wouldn’t be a bad idea. That is also when she told me that she had received a communication from the wound care center about my wound. That sort of threw me for a loop because the nurses rarely if ever get communications about me. She then proceeded to tell me that the communication said that my wound had some depth that she was unaware of. What had happened by this point was that the opening of my wound had become so small, my visiting nurses were having trouble getting any instruments inside of it to measure the depth. Visually they thought it was doing well but they couldn’t really be sure. The depth that she told me seemed that it had to have been completely outdated but there was no way to be sure at that point because she didn’t have a copy with her to check the dates. I felt that the communication was outdated because I am all but certain that the number was not one that would have caused my surgeon’s excitement a month earlier. I was going to the wound care center two days later so I intended to mention both the weird measurement communication and my idea to switch to the Hydrofera Blue while I was there.
When I got to the wound care center the nurse took the dressing off and then didn’t really say much of anything. I also, didn’t bother to ask because I knew my surgeon would be in shortly. When my surgeon came in, before I had really even gotten a chance to tell him my idea about changing to Hydrofera Blue or to ask about the strange communication my nurse had received, he came over and examined my wound. Then he said something completely unexpected, “I’m calling that healed”. By then, my surgeon came over to the other side of the bed so he could actually see my face. I have to say I don’t think I gave him the reaction that he was exactly looking for because well frankly, I did not believe it. He asked me if it was something the nurses said that had me feeling a little unsure and I said yes, but before I really got to tell him what exactly she said, we got talking about other things. I think I was so thrown off by that news because I could not get the strange measurement from the communication that my visiting nurse had told me about out of my head.
My surgeon then told me that he wanted us to lay a piece of calcium alginate over top of the wound and then put a dressing on top of it, “just to absorb any drainage and to provide some more protection for it”. He told me to come back a couple of weeks later so that he could be sure. Due to a scheduling conflict I told him that two weeks was not an option so he could choose either seeing me the following week or to wait and see me in three weeks. He then said to come back the next week.
I left the appointment unsure how to feel. While I was happy to hear that my wound was supposedly closed I was also thinking about the times I had heard before that it was closed. The previous times I had gotten very happy very quickly and then it had reopened so this time around I was a little hesitant to get excited. Being that I was so cautious I decided to really only tell my boyfriend what my surgeon had said. I decided that because before when I had told everyone and their mother about it being closed it had reopened and the look on those people’s faces was too much for me to handle so I was going to keep quiet about it for awhile, this time.
Two days later when a visiting nurse came I explained to her what all had gone on at the appointment and what the wound care orders had been changed to. I also, told her that while I fully trust my surgeon while I believe HIM, I did not necessarily believe IT when he told me. She laughed and said that it sort of made sense to her, if that was how I “wanted to spin it”. My nurse then examined the wound and she said that it was doing incredibly well, that it had no drainage but that one part of it may still have been open. I was neither surprised nor upset upon hearing that. Mostly because I just didn’t get the “it’s done” feeling. She then dressed the wound and told me that the other nurse would be out to see me in a few days.
The next nurse that came was the one that I do trust and that I have always had a close relationship with so when she came in and I told her what was going on she had said that she would tell me what she thought. When she looked at it, she said that it is closed. I believed her but still was hesitant, she then said that she poked at it rather aggressively and that nothing happened. My response to this news was “eh, ok, if you say so; but I’m still not telling anyone yet. She laughed but told me that she understood why I was being so incredibly cautious this time around. Before she left, she asked me to call her after I see my surgeon to give her an update, which just happens to be tomorrow. Stay tuned.
My visiting nurses continued to fill the wound with collagen of one form or another for several weeks after the surgery. It seemed to me that the wound was progressing, slowly but still moving forward. During a visit to the wound care center my surgeon mentioned maybe wanting us to change what we were using, just to jumpstart the healing again. He thought that we should maybe switch back to using the Hydrofera Blue. That was when he asked about how much drainage we were noticing and I told him that it was still heavily draining. At that point my surgeon decided not to put in the Hydrofera Blue because he felt that it might just plug the drainage in the wound and not let it escape. I agreed and went home with instructions to continue using Collagen inside of the wound and the same Tegaderm foam dressing on top of it that we had been using.
The visiting nurses and I continued following my surgeon’s instructions and we were seeing some progress. I was happy to hear that things were going well but was still taking most of the good news with cautious optimism, with an emphasis on the cautious. In the beginning of December I went to my regular appointment at the wound care center and when my surgeon probed inside the wound to see what the depth was he was very happy. Actually, it was one of the few times when I had heard him really “up” about how it was doing. After I laughed about his reaction he told me to just keep doing what we were doing and to come back in two weeks so he could assess my wound again.
During the couple weeks I was waiting to go back to the wound care center my nurses started to become more and more pleased with my wound. The drainage was starting to decrease and the depth started to become less. The next time I saw my surgeon he was also pleased and told me to keep going with the collagen and see him again a few weeks later.
After about a week I mentioned to one of my visiting nurses that I had been thinking. Me thinking? Wait a minute; this could either be really good or really bad. See, as I have said wound care was continuing to take over my life and once in awhile I found myself unable to get wound care out of my head. I mentioned to her that my surgeon was at one point considering changing to Hydrofera Blue but he was concerned about having too much drainage. Based on the fact that we were noticing the drainage had decreased and had been on the collagen for approximately nine weeks I was thinking about mentioning to him that maybe that point would be a good time to switch what we were doing. My nurse agreed with my thinking and told me that it couldn’t hurt to bring it up with him at the following visit.
A couple of days later I had another visit from a nurse, this time it wasn’t the one that I was super comfortable with, but the one that I had been taking almost everything she said with a grain of salt. I mentioned my idea to her and she also told me that mentioning it wouldn’t be a bad idea. That is also when she told me that she had received a communication from the wound care center about my wound. That sort of threw me for a loop because the nurses rarely if ever get communications about me. She then proceeded to tell me that the communication said that my wound had some depth that she was unaware of. What had happened by this point was that the opening of my wound had become so small, my visiting nurses were having trouble getting any instruments inside of it to measure the depth. Visually they thought it was doing well but they couldn’t really be sure. The depth that she told me seemed that it had to have been completely outdated but there was no way to be sure at that point because she didn’t have a copy with her to check the dates. I felt that the communication was outdated because I am all but certain that the number was not one that would have caused my surgeon’s excitement a month earlier. I was going to the wound care center two days later so I intended to mention both the weird measurement communication and my idea to switch to the Hydrofera Blue while I was there.
When I got to the wound care center the nurse took the dressing off and then didn’t really say much of anything. I also, didn’t bother to ask because I knew my surgeon would be in shortly. When my surgeon came in, before I had really even gotten a chance to tell him my idea about changing to Hydrofera Blue or to ask about the strange communication my nurse had received, he came over and examined my wound. Then he said something completely unexpected, “I’m calling that healed”. By then, my surgeon came over to the other side of the bed so he could actually see my face. I have to say I don’t think I gave him the reaction that he was exactly looking for because well frankly, I did not believe it. He asked me if it was something the nurses said that had me feeling a little unsure and I said yes, but before I really got to tell him what exactly she said, we got talking about other things. I think I was so thrown off by that news because I could not get the strange measurement from the communication that my visiting nurse had told me about out of my head.
My surgeon then told me that he wanted us to lay a piece of calcium alginate over top of the wound and then put a dressing on top of it, “just to absorb any drainage and to provide some more protection for it”. He told me to come back a couple of weeks later so that he could be sure. Due to a scheduling conflict I told him that two weeks was not an option so he could choose either seeing me the following week or to wait and see me in three weeks. He then said to come back the next week.
I left the appointment unsure how to feel. While I was happy to hear that my wound was supposedly closed I was also thinking about the times I had heard before that it was closed. The previous times I had gotten very happy very quickly and then it had reopened so this time around I was a little hesitant to get excited. Being that I was so cautious I decided to really only tell my boyfriend what my surgeon had said. I decided that because before when I had told everyone and their mother about it being closed it had reopened and the look on those people’s faces was too much for me to handle so I was going to keep quiet about it for awhile, this time.
Two days later when a visiting nurse came I explained to her what all had gone on at the appointment and what the wound care orders had been changed to. I also, told her that while I fully trust my surgeon while I believe HIM, I did not necessarily believe IT when he told me. She laughed and said that it sort of made sense to her, if that was how I “wanted to spin it”. My nurse then examined the wound and she said that it was doing incredibly well, that it had no drainage but that one part of it may still have been open. I was neither surprised nor upset upon hearing that. Mostly because I just didn’t get the “it’s done” feeling. She then dressed the wound and told me that the other nurse would be out to see me in a few days.
The next nurse that came was the one that I do trust and that I have always had a close relationship with so when she came in and I told her what was going on she had said that she would tell me what she thought. When she looked at it, she said that it is closed. I believed her but still was hesitant, she then said that she poked at it rather aggressively and that nothing happened. My response to this news was “eh, ok, if you say so; but I’m still not telling anyone yet. She laughed but told me that she understood why I was being so incredibly cautious this time around. Before she left, she asked me to call her after I see my surgeon to give her an update, which just happens to be tomorrow. Stay tuned.
Sunday, January 6, 2013
Surgery Recovery and Miscommunication
After a quick stop at the pharmacy to pick up the prescription for pain meds, I went home to rest and await my visiting nurse who was scheduled for the next day. When my nurse came she asked how my pain level was and I explained that while I was sometimes uncomfortable, it was easily controlled with my prescription. She also, asked what exactly had been done in the operating room and what the orders were as far as the wound care itself was concerned. I explained to her that during the surgery the wound had been cleaned up back to healthy bone and then filled with antibiotic seeds and then a type of Prisma collagen was placed inside the wound. The collagen that was inside the wound and the antibiotic seeds would all start to be absorbed by my body as such the only thing that my nurse would need to do for the next few visits, would be to change the outer dressing and monitor the amount of drainage.
I saw my surgeon at the wound care center about a week later. During which time he added Promogran (another collagen) to the wound and explained to me that he still only wanted my visiting nurses to change the outer dressing and that he wanted to see me weekly. He needed to see me weekly so that he himself could add the collagen after it had been given a chance to be absorbed. That way not everyone was poking around inside the wound, therefore hopefully giving it the best chance to heal.
Following those instructions was going very well and my surgeon seemed pleased with the progress of the wound. A few weeks later, my surgeon explained that he needed me to skip a week with him so as I was leaving a made an appointment for two weeks later. When I next saw my visiting nurse I explained to her that I was skipping a week at the wound care center but that I had completely forgotten to ask what should be done about the collagen that was to be replenished weekly. My nurse told me that at that point it was fine because it had only been a couple days and we had time to get in touch with the wound care center before it would need to be changed anyway.
I called the wound care center and spoke with the nurse that had last been in the room during a visit with the surgeon to ask her what she thought we should do during the time I would not be seen by my surgeon. The nurse that I spoke with was one that although I do not have a problem with her per say, I do not feel like her and I communicate very well. When I asked her what I should do after the collagen was in for a week all she really said was that it “dissolves into the wound” I explained that I knew that already and then asked in what I thought was a different way that would maybe get me an answer. I even pulled out the big guns and used the word “replenish” in the sense of “what should we use to replenish the amount of collagen once this has been in all week”. The nurse continued to just tell me that my body absorbs the collagen but never really told me what to add once it had been in for the week.
When my visiting nurse came I explained to her that I had tried to get us an answer but hadn’t been very successful. She was frustrated by the lack of information but was mostly just amused that I had asked several different ways and still the nurse was unable to at the least reply with “I do not know, let me speak with the doctor and get back to you”. I was also amused so I laughed about it, with the intention of calling my surgeon a few days later for a straight answer. A few days later I found myself calling my surgeon directly so that I could get further instructions. I had no problem calling being that this was a completely legitimate question, however, I did sort of feel like a fool for not having asked him before I had left. When I spoke with my surgeon and asked my question he then asked me what supplies I had in my wound supplies box so that hopefully he could just pick something I already had. He was able to suggest using another kind of collagen and told me that kind should be changed a few times a week so the nurses could start filling the wound with that and he would see me the following week.
I saw my surgeon at the wound care center about a week later. During which time he added Promogran (another collagen) to the wound and explained to me that he still only wanted my visiting nurses to change the outer dressing and that he wanted to see me weekly. He needed to see me weekly so that he himself could add the collagen after it had been given a chance to be absorbed. That way not everyone was poking around inside the wound, therefore hopefully giving it the best chance to heal.
Following those instructions was going very well and my surgeon seemed pleased with the progress of the wound. A few weeks later, my surgeon explained that he needed me to skip a week with him so as I was leaving a made an appointment for two weeks later. When I next saw my visiting nurse I explained to her that I was skipping a week at the wound care center but that I had completely forgotten to ask what should be done about the collagen that was to be replenished weekly. My nurse told me that at that point it was fine because it had only been a couple days and we had time to get in touch with the wound care center before it would need to be changed anyway.
I called the wound care center and spoke with the nurse that had last been in the room during a visit with the surgeon to ask her what she thought we should do during the time I would not be seen by my surgeon. The nurse that I spoke with was one that although I do not have a problem with her per say, I do not feel like her and I communicate very well. When I asked her what I should do after the collagen was in for a week all she really said was that it “dissolves into the wound” I explained that I knew that already and then asked in what I thought was a different way that would maybe get me an answer. I even pulled out the big guns and used the word “replenish” in the sense of “what should we use to replenish the amount of collagen once this has been in all week”. The nurse continued to just tell me that my body absorbs the collagen but never really told me what to add once it had been in for the week.
When my visiting nurse came I explained to her that I had tried to get us an answer but hadn’t been very successful. She was frustrated by the lack of information but was mostly just amused that I had asked several different ways and still the nurse was unable to at the least reply with “I do not know, let me speak with the doctor and get back to you”. I was also amused so I laughed about it, with the intention of calling my surgeon a few days later for a straight answer. A few days later I found myself calling my surgeon directly so that I could get further instructions. I had no problem calling being that this was a completely legitimate question, however, I did sort of feel like a fool for not having asked him before I had left. When I spoke with my surgeon and asked my question he then asked me what supplies I had in my wound supplies box so that hopefully he could just pick something I already had. He was able to suggest using another kind of collagen and told me that kind should be changed a few times a week so the nurses could start filling the wound with that and he would see me the following week.
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