30 November 2021
Both of us met with Dr. Tong today at the clinic. It was a relief to her to be able to speak to the two of us in the same room, she said.
When I spoke to her on the phone Saturday, she said she had some ideas to discuss with us. And she did.
She said she had learned that the radiation damaged her leg muscle groups. When she stimulated a few of them, they barely twitched. One group did respond and that's the one causing Joyce such pain during the dressing changes.
There's blood flow to those muscles so she doesn't want to remove them. They aren't dead just not functional. That explains Joyce's difficulty walking and her preference for being sedentary lately after enjoying her walks so much.
The tissue damage from radiation is what's preventing the wound from healing. It would have to be pristine to progress, she said. Which would mean being in the hospital and going into surgery whenever the yellow slough started growing. Meanwhile, she would be on a Wound VAC in the hospital. Just the way she was for a month a few weeks ago.
That was really the only time the wound was able to heal.
There are three ways to proceed, she said.
- The first is that we can just continue going on with the wet-to-dry dressing changes, two a day. Forever. The problem with this is that it risks squamous cell carcinoma, which is very difficult to detect before it metastasizes. In short, it's a death sentence. One thing in her favor here is that she's had this wound for nearly a decade without developing squamous cell carcinoma.
- The second is that she would go back into the hospital, probably early next year, and clean up the wound in preparation for an application of Integra, the bovine tissue, that would, if takes in three weeks allow them to do a skin graft and close the wound. That's a big if. The existing cells have to be healthy enough to grab the Integra tissue and incorporate it.
- The third is taking muscle tissue from the other leg, cutting into the main artery in her wound leg and branch a blood supply to the transplanted tissue. The operation itself is about 10 hours and requires extensive hospitalization. It's a last resort, she said. But if it works, "you'll never see me again," she laughed.
No decision is necessary now, she added, and in fact, we are proceeded with the first approach for the time being. Treading water, I called it, because the wound won't heal this way.
But even doing the Wound VAC at home isn't sufficient, we've learned. The yellow slough forms because the radiated cells are not strong enough to grow quickly and prevent the slough from forming. She would have to be hospitalized and returned to surgery whenever the slough formed for the Wound VAC to help.
When she changed Joyce's dressing she got a look at the wound and showed me where the twitching muscle is.
And she ordered a new antibiotic that will attack the three forms of bacteria the culture she took on Saturday revealed. They're more serious than the common skin bacteria, she said, living deeper in the wound.
She acknowledge there are two competing concerns: wound health and well being. At the moment it feels like Joyce's well being is more important than wound health, which has not improved. But Joyce is near the end of her rope with this.
"I can't take it anymore," she says. More and more often.