January 15 - Turf wars

OK, maybe "wars" is a little strong, but I'm pretty sure I stepped on some toes.

With the continued non-healing wound frustration, my co-workers suggested I talk to our home care wound nurse. She's new, having started with us while I was off in September, but she has years of experience and strikes me as an "old school" gal. Strict, no-nonsense, smart... intimidating.

But, since I'll bare my chest to anyone these days, and nothing else feels like it's working, I thought I'd ask her for help. She promptly tossed out a couple of theories, took a look, revised her ideas and said she'd get something out of her car. Before I knew what was up, she had pulled some things together and had a new concoction applied to me.

Good news: she offered to change the dressings for me any time and I can shower with them on and they stay in place for several days. Yea!
Not so good news: I suddenly felt guilty that I was bypassing the wound care expert I've been working with for 3 months (at $1000/month!).

So I promptly called Christine to fill her in on the new regime. She was not happy, but knows patients rarely follow directions or do what's best for them. I'll see her Thursday and I'm praying for miraculous results.

I also left a message for Dr. Shulman. She called me back and left me her cell phone number (I may store that in my phone). When we finally caught up with each other, she ran through a couple ideas - none of which I liked. First of all she said she's never had this happen with a patient before. She said we could (a) continue the antibiotics, (b) remove some fluid from the expanders, (c) change dressing types/procedures and/or (d) surgically re-open everything and try to close is back up again.

I don't like any of those options. (a) the skin was falling off after being on antibiotics for 1 1/2 weeks, (b) there's plenty of gush and skin mobility - it's not that tight, (c) already trying that, (d) ummm - isn't that what started this in the first place? I shared my opinion with Dr. Shulman.

Scott also pointed out I'm not having trouble healing from anything else - paper cuts, bruised knees, hangnails. So Dr. Shulman thought the healing delay may be related to the Alloderm grafts - that is, cadaver dermis that she uses to hold the tissue expander in place to create a reasonably boob-like shape. She says it takes about 6 months to fully vascularize through the Alloderm, and so the blood supply just may not be strong enough to support epithelial growth. Weird since the blood drips down my stomach whenever the dressings are off, but it's the best idea we've got.

I guess that means we're in a holding pattern for at least another 6 weeks. If nothing changes by then, she'll probably resect the open area and try to stitch it back together.