5 February 2021
Just got off the phone with Dr. Tong after she cleaned up Joyce's wound a little later today than she had hoped. As an "add-on" surgery, Joyce had to wait until the more major surgeries were completed -- and things got backed up today.
Dr. Tong was a little concerned that Joyce refused the epidermal catheter to deliver pain relief but it can still be placed tomorrow if Joyce experiences more pain from the procedure than she can tolerate over the weekend.
The procedure was to remove the yellow tissue from the wound, which exposes the nerve endings (which, like the pink fat tissue, are growing into the wound). That's the painful part.
Once the yellow tissue was removed, a black foam dressing was put in the wound to seal it and promote healing. Dr. Tong did not use the Adaptic mesh, though.
She wanted me to know that it isn't likely Joyce will be coming home tomorrow and she would like her to stay through Monday to see how she tolerates the dressing change. Which is exactly what I had recommended to Joyce earlier.
She wanted me to know that it isn't likely Joyce will be coming home tomorrow and she would like her to stay through Monday to see how she tolerates the dressing change.
Better to be in the hospital with an anesthesiologist handy than at home with an LVN trying to change the dressing if you are experiencing acute pain.
Dr. Tong thought the healing progress has been very slow, on a three-year pace. To speed things up, she is thinking about a couple of options.
The first is holding off on the black foam vacuum dressings and using a two-a-day wet dressing that will be painful for a couple of weeks before showing more rapid tissue growth of the fat cells.
It's hard to get a nurse to come out twice a day, she admitted, and asked how I felt about doing it. I told her I don't know the procedure but I've been able to do the wound cleaning, abscess packing, lily pad replacement, drape replacement, leak patching and psychological counseling (just kidding) so far.
How fast did I do them, she asked. As fast as or faster than the nurses. Fifteen minutes, wind aided.
She said there are videos demonstrating the techniques and maybe they could get me in the hospital to show me what to do. But in any case, I've apparently volunteered.
Another possibility is a procedure available at St. Francis hospital that would require approval from Kaiser, since it's an outside-the-network provider. It exposes the wound to a pure oxygen environment to promote tissue growth but it has to be done every day for 20 minutes to half an hour, two hours all together. It sounds like a long shot.
What is not a possibility, she clarified when I asked, is transplanting tissue from another part of her body into the cavity. She will do a skin graft but not until they get more fat tissue to grow in the wound. She said transplanting fat tissue into the wound be on the order of a face transplant and take something like 10 hours. They do that, she said, but this doesn't rise to that level.
Meanwhile she said patients with help at home do a lot better than those without it. And she said she can see Joyce has a lot of support. The nurses, I pointed out, have been terrific.
So the plan now is to see how much pain she is in over the weekend and how she tolerates the dressing change on Monday.
When she can tolerate the pain, she can go home.