Saturday, July 20, 2013

Post-cruise ooze

Our last post ended with my sister Laura picking Mom up from dialysis around noon on Wednesday, July 3. Before Mom came out, the nurse Laura had spoken to that morning told Laura that Mom was running a slight fever (around 100) and the surgery site was oozing a little and definitely infected. She said they would definitely not do the heart catheterization procedure scheduled for Friday if she was running a fever due to infection. She told Laura that if Mom could not see a doctor about it today she needed to go to an emergency room to have it looked at and probably have the abscess drained.

Laura took Mom home and they called Dr. K's office from there. They had to leave a message with his answering service since his office was closed until 2:00 PM. Things got more interesting around 1:30 PM when Mom's temperature went up to 103. Laura called Dr. K's office shortly after 2:00 PM and told them Mom's temperature was now 103 and she was taking her to an emergency room, and asked them which hospital they wanted Mom to go to. The nurse put Laura on hold while she talked to Dr. K, and then told Laura to bring her to Dr. K's office.

Due to Laura's schedule my sister Amy had to take Mom to Dr. K's office. She called me from there around 3:30 PM and said Mom was going to be admitted to Baylor Heart Hospital, which is just two buildings over from Dr. K's office. Dr. K spoke to me briefly and said he would try to get her scheduled for surgery today, and he would probably leave the wound open so she would be in the hospital for one or two days. So Friday's heart catheterization will need to be cancelled.

They got Mom prepped for surgery and took her to the operating room around 5:00 PM. Amy called me at 5:35 PM and said the surgery was done, with no complications. They did leave the wound open for healing purposes. Dr. K said he was going to arrange a home health care nurse to come to Mom's house to change the dressing and do some sort of vacuum procedure on the wound. We had no idea what that was all about, but we learned later.

I got to the hospital around 6:30 PM, and Mom was still groggy and coming in and out of consciousness. She gradually woke up and was able to eat some dinner before 8:00 PM, and I stayed until about 10 PM.

Mom got to spend the Fourth of July in the hospital, and I know she got at least nine visitors that day (not counting doctors and nurses). Laura was there in the morning when the dressing on Mom's wound was changed. Mom and Laura were surprised at how large the hole was once the nurse pulled out all the gauze. It's about 1.5 inches deep (3.8 cm) and at least 1 inch by 2 inches across (2.5 cm x 5 cm). No, I don't have a picture of it.

Some good news is that Mom's hemoglobin is still over 11 even though she did not get any Epogen while she was on the cruise. So maybe her anemia is getting under control now and she will start feeling better once this infection is behind us.

Mom had dialysis in the hospital the morning of Friday, July 5, and after that they installed the vacuum thing. I still did not know what the vacuum was all about, so I hit the internets and discovered it is called negative pressure wound therapy. The wound is stuffed with a sponge-like material, then a clear dressing is applied to create a seal around the wound. A tube is attached to the seal and to a vacuum pump that the patient has to keep on their person or nearby at all times. This constant vacuum on the wound promotes healing and reduces infection by increasing the blood flow to the wound and drawing out any discharge. The pump needs to be plugged into a power source as much as possible to keep the battery charged, but it can be unplugged for up to four hours at a time. Speaking of discharge, Mom was discharged from the hospital late Friday afternoon.

I went over to Mom's house on Saturday to see how she was doing and to check out the pump. She has about ten feet (3 meters) of clear plastic tubing, with one end attached to her abdomen and the other end attached to the pump. Her wound is packed with gauze, with a black sponge-like material on top covering that. The sponge is maybe 3 inches (7.6 cm) in diameter, so the wound is smaller than that. On top of the black sponge is what looks like a clear rubber suction cup. The plastic tubing is attached to this suction cup, at a right angle so the tubing is against her body instead of protruding straight out. Covering the suction cup and black sponge is what looks like shipping tape, but it is actually the dressing used to create a seal so the vacuum will work. The area with this clear dressing is at least 6 inches x 6 inches (15 cm x 15 cm). Yes, I took a picture. No, I'm not going to put it on the blog, even though it isn't very gross.

The pump itself is about the size of a small purse or a large pocketbook, and weighs 2.4 lbs. (1.1 kg). It has a carrying case with a shoulder strap so the patient can carry it around. The manufacturer is KCI, and it is the KCI ActiV.A.C. Here is the link to the product web page if you would like to learn more about it, including specifications and the full manual: http://www.kci1.com/KCI1/activactherapyunit. It makes a quiet "clunk" sound every few seconds, and occasionally it makes a gurgling sound, which I suppose is when some fluid reaches the pump. I only saw a few spots of fluid in the tubing, so it's not like the wound is constantly oozing at this point.

As if Mom was not tied down enough with dialysis three times each week, now she has to carry this pump everywhere with her and keep it plugged in most of the time. Just going from room to room inside her house becomes a bit of a hassle now. What makes it even better is that she cannot take a shower with this wound dressing. They told her she would probably need the pump two to three weeks. Wonderful.

With this wound vac the hospital arranged for a home health care nurse to come to Mom's house three times each week to change the dressing and make sure everything is still working properly. That will happen on Monday, Wednesday and Friday mornings, before Mom goes to dialysis. The next blog post will start with this first visit from the home health care nurse.

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