I have truly struggled these past months with what to type…how much do I share? And what pictures to share. I have been at a Loss for Words. Nothing could have prepared me for what was to come. What I am about to share will be a quick synopsis of what has happened since my Diep Flap surgery on October 24th. The surgery that I thought would be my final major surgery in regards to breast reconstruction of my left breast. I will not include sensitive pictures with this blog, the sensitive pictures will be included in a blog pictorial. Blog pictorial #65 WILL have graphic pictures so if you don’t want to see them just don’t scroll down past this blog.
Wednesday October 24th, we arrived at Eisenhower Medical Center before the sun came up, what was to be a 10 hour surgery was 13 hours! Wednesday, Thursday and most of Friday was spent in ICU. I was transferred to Med-surg late Friday the 26th and discharged on Sunday the 28th. My first post-op appointment went really well which was on Friday November 2nd. Everything was going well I even managed to get out and vote on election day!
Wednesday November 7th I noticed an odor coming from the flap, however due to the Xeroform being used over the blisters on the flap I thought it was that. Also my next post-op appointment with my PS was in two days. My appointment on Friday November 9th was at 1:00. My dressing was removed…Dr. Eko immediately talks about the need for a debridement! Then the words I was not expecting….this would be done under general anesthesia! By 6pm that evening I as having an unscheduled surgery. Dr. Eko suspected that a hematoma formed on top of the preforator, when he placed the dopler where it was, there was to sound. He was going to do the debridement, check the vascularity of the flap…basically he was going to try and save the flap. This surgery was about 7 hours long and I received 2 blood transfusions. A culture was taken and sent to the lab of the wound. If you chose to look at the photos, the picture taken on November 10th, it is obvious that the flap has lost blood flow! And yes, I had formed a very large hematoma on top of the preforator.
On Sunday November 11th I was having yet another surgery…this one to remove the failed Diep flap. However, what was next? I only had a plan A and B! This was not happening…my option..Lattissimus dorsi flap. This surgery took about 8 hours and yet again I required 2 more blood transfusions. After the Diep flap (skin from my abdomen) and the adipose tissue was removed and disposed of, a tissue expander was placed (for future skin expansion) and then the muscle was brought from my back, then covered with skin from my donor sight ( upper left thigh)… I was in ICU, when I awoke I learned that the culture that was taken and sent to the lab from Fridays surgery came back positive for not one, not two but three bacterial infections!!!! Worst one being a “Rare growth of Pseudomonas Aeruginosa” WTF!!! So now I have to be seen by an infectious disease doctor! In comes Dr. Dezfuli. The way I see it, IF the Diep had not failed this infection would not have been discovered, the infection would have gone to my blood stream causing sepsis. I had a would vac over the new flap, the wound vac was on me for 6 days. I was also started on an I.V. antibiotic called Cefepine.
The goal was to discharge me on November 17th, however due to case management being unable to coordinate home health care with infusion therapy in time prior to my discharge I was not discharged until Monday the 19th.
I was in the hospital from Friday November 9th till the 19th (11 days), 4 blood transfusions, and a wound vac attached to me for 6 days. When I was discharged I would continue to get I.V. antibiotics. Arrangements were made with home health care, so while everyone is getting Amazon packages delivered for the holidays we were receiving medical supplies from Optioncare. Cefepine 3x daily via my Pic-line.
On Thanksgiving when my husband did my dressing change he didn’t like the way the blackened area where the infection was looked. He took a picture and sent it too my surgeon (on Thanksgiving). Dr. Eko called my husband and asked if we can meet him in his office the next day ( I wasn’t planning on going Black Friday shopping anyways!) So there we go, to his office by 11 am. Keep in mind, he has no office staff it was just us. Thank god my daughter Monique who just so happens to be a nurse extraordinaire came with as she assisted Dr. Eko in what was to come. After several Lidocaine injections from the bottom up and around to the sternum, he opened up the flap to find that there was still too much evidence of the Pseudomonas infection, he cleaned up the mucus and deflated the expander removing the 350cc’s of saline to relieve pressure from the flap. He then talked to me about removing the expander all together. At this point it was more important to get a hold (control) of the infection then to keep the expander in. So out comes the expander…..shall I mention that my daughter Jax was holding my hand and got wooozy, had to leave the room and proceeded to pass out! Never a dull moment! Again he did a culture, having to hand deliver the swab to the Lab at Eisenhower himself due to the holiday. Dr. Eko also called the infectious disease doctor and they agreed that I was in need of a stronger antibiotic. Now besides the Cefepine 3x daily (every 8 hours) I am receiving Vancomycin 2x daily (every 12 hours)…making me a slave to my home not being able to go out and about ( not that I wanted to…initially) the plan is a total of 6 weeks of treatment with the I.V. antibiotics.
Christmas has come and gone, my daily routine is Cefepine 630am followed by Vanco, total drip time about 3 hours. If I have doctors appointments and the second dose of Cefe is administered a little behind schedule then the third dose is really late in the evening, ending sometimes a 1am!…..repeat.
This coming week will be my final week on the I.V. antibiotics, January 4th is the scheduled last day. On Thursday January 3rd, I see Dr. Eko, he will examine the would and is supposed to remove the dressing from my thigh, I am not looking forward to that.
I realize that everyones time is precious, if you have read this blog I thank you.
Mahalo, Pina
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