5 April 2022
After today's hyperbaric oxygen therapy, we came home to await a 4:45 p.m. phone call from Dr. Tong.
But first, Jennifer the Physician's Assistant called to tell us the cultures Dr. Tong took during Saturday morning's surgery have been analyzed by the infectious diseases doctor who has prescribed two new antibiotics.
And we can pick them up tomorrow at French hospital.
Which was all very clear to me but Joyce, on Norco, needed to hear it a few times. And even then, she wasn't sure what to do when.
Then Dr. Tong called.
It was the kind of call I usually have with her after surgery. And, I suspect, what she usually talks to Joyce about after surgery. But since surgery was in the middle of the night, this was the first time any of us had to talk about it.
The muscle, she began, is pretty dead. The stimulator showed no activity.
However you fold it, it isn't good news.
And she found the slough was covering scar tissue. There are now white fat cells, just yellow and white scar tissue. All that prevents the pink granulation of good tissue from forming and closing the wound. Or just grabbing onto the Integra so the wound can be closed with a skin graft.
She didn't think the Integra was going to work after all.
So she called Dr. Fang, who did the originally surgery to remove the sarcoma, and she called "The Chief" in Oakland (who is on vacation) to consult on the case.
She again mentioned the flap as an option. That's the 10 hour surgery that reroutes blood vessels and is extremely risky. But it's also the first thing Dr. Fang mentioned when he saw Joyce's wound and sent her to Dr. Tong.
So after she talks to them, she'll get back to us and we'll probably end up visiting one or both of them as well.
Meanwhile, she's making an appointment for surgery on a Friday in three weeks, which can be canceled if not necessary but will prevent these middle-of-the-night interventions like last Friday-Saturday.
And she's hoping the hyperbaric oxygen therapy revives the tissue enough to show some life in the wound.
I had discussed this with Thurman, the hyperbaric unit director, a few days ago. He's been at this eight years and seen larger wounds than Joyce's close with this therapy. We're at the telling point now, 21 sessions in. But 40 we should see something happening.
Dr. Mallon, one of the two MDs associated with the program, thought she might need something like 60 sessions, the maximum before a patient has to take a break to preserve their vision (which can be distorted by the pressure but does, in a few weeks, return to normal).
However you fold it, it isn't good news. As I told Dr. Tong, "We understand that." We haven't heard good news for a long time.
At dinner tonight, Joyce regretted not doing something sooner. I suppose that's the lesson of all these medical tales.