Skin / Capillaries look dead to surgeon

sas-schatzi

A minute ago sas-schatzi wrote:

A few seconds ago sas-schatzi wrote:

Friends I'm reposting this here----------it has implications for you and your childern. Many of you don't post where you might see this.

2 minutes ago, edited a few seconds ago by sas-schatzi wrote:  I'm re-postig this from another thread. tested hyperlink. There are implications , not just for us, but all women and childern males as well as females. Children being exposed to high levels of estrogen. Could explain why early onset puberty has been such a problem. AND newborns being born that have signs of going through puberty.

Hillck-----I'm even more bummed that article was published in DEC 2006. It should have been a Public Health Warning issued from some agency. You noticed that at the end of the article they said they were going to lay low. It was fascinating that the Mongolians to empirically figure this out and have been doing it for 2 thousand years. That's HUGE.

TO ALL---read the below hyperlink.-----How it affects us is--Now we may have to make choices about milk.

Another thought the government has NOT dealt with the public impact of what this article identifies. Guess it's not politically correct.

I'm going to add the hyperlink here and re-post it on a couple of threads.

http://news.harvard.edu/gazette/2006/12.07/11-dairy.html

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jyg

Maybe post this in a different forum section if you want the link seen by those who might be more interested?

sas-schatzi

JYG- any thing you find interesting? That helped---------It's been suggested for posting--------can't do

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A few seconds ago sas-schatzi wrote:

No one to my knowledge has tested charts yet. They are NEVER washed. They must be a hotbed of bacteria. Think of all the hands that touch them. I believe they need to go through a high temperature wash after each use. If a patient is there over so many days the chart should be changed and sent through a high temperature wash with chemicals etc.-------Periodically, you will see studies that show lots of other things that have been tested, even Doc's ties(awful), stethoscopes, handheld cells, phones, EKG leads, computer keyboards. Other nurses used to laugh at my OCD of cleaning at the start of each shift. I was not only trying to protect the patients, but US.

Started with noticing zits, in a certain pattern on my face. I went through puberty, basically, without zits. Then noticed a similar pattern on the other nurses. Cell phones in hospital were handed off to each other at shift change. My research showed a really good study out of Israel on the topic. The four studies from Usa were all lazy studies. They all sited the Israel study versus doing any of their own microbial studies. Except one that sited a study of the Bacteria on EKG leads. Hand wiping EKG leads did little to remove bacteria. The study recommendation at the time was for disposable leads, but they weren't dependable enough at the time. Imagine my horror when waking up after my failed chemo that almost killed me, and they had put on telemetry leads across still healing Mastectomy wounds. Off they came--pronto. The nurse taking care of me reacted in disgust that I was so uncooperative with my CARE.

I felt like Felix Unger in the" Odd Couple". I'd have a talk with all newbies about cleaning the cells and beepers before handing them off. Even for break coverage, let alown at shift change. Cleaning their medication binders, the computer and Pixis keyboards.

Also. nix on fake nails-----horrible. First reports came in 1998. It took several years for it to become the rule. It only happened after Joint Commission on Hospital Accreditation made it a "recommendation" and that they would be looking for policies  on it.

If a doc comes in with a dirty lab coat send him on his way, No hand washing by anyone---speak up. Hand washing should go up to at least 4-5 inches up the arm

Jewelry even wedding bands should be outlawed.

Watches should be done away with in hospitals. They have clocks in every room. They just need to have a sweep hand to do pulses.

 All this stuff can be googled. I should think where else this can be posted. People can't protect themselves against that which they don't know about.

All IV poles and commodes should go through a big wash container. Suggested this for the new hospital for OR tables, they did it.

 Anyone throwing dirty linen on the floor should be retrained. Each room should have it's own linen container ----not taken from room to room , or carried down the hall.

Each person should be given there own BP cuff------This is becoming more common.

Each person should be given a new phone----This is also becoming more common.

 Shoe covers should be used by in hospital personnel, changed after leaving a room that has a known infection----now only done with serious infections that are in isolation status. Not even required by many hospitals for OR people.

As there are many more hospital acquired infections, a return to things that were done in a previous time are being looked at for control of the spread of hospiatl acquired infections. 

Lastly, I believe that all immuno-comprimised patients should be in reverse isolation for our full hospital visit. That's all of us that are receiving chemo or recently received chemo, but are numbers are "UP". Our immune systems are not the same after all the chemicals dumped into us. We need greater protection from what we are exposed too. Numbers being "up" doesn't tell the whole story. This one I can't prove by studies. Wish I could. But been there did that , seen it to often that we are more prone to infections based on our life saving drugs like Tamox and AI's.

Well this chapter is at an end.

sas-schatzi

Anyone interested I wrote a new topic thread on constipation------ah the things we share-sheila

http://community.breastcancer.org/forum/6/topic/781867?page=1#post_2830873

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bump for NancyL&H sheila

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Bump  for nancy

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Bump------for those with wounds that need tending

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Bump----read thead from beginning, has much info from many giving people sheila

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sas-schatzi

member name deleted      Based on what I see here from your description and all the members responses . The pyhsical description appears to be improving ? Is that true. Redness reduced, heat reduced, fever reduced. YOu Have been seen by a doc daily.   It appears to be improving versus getting worse? You are taking pictures daily.Lay them out sequentially, in good light with no shadows. That will show color progression, which is important in evaluating getting worse or better. You already established that the skin was hot and now it's not, You state no systemic temperature. I think stated amount injected was 2cc , but you described a baseball size lump. that falls more into description of possible tissue reaction to the drug, abcess from the injection itself, Hematoma from hitting a blood vessel that ultimately sealed it self off.  What the body does is seal off an area in the occurence of anyone of the three.

Your symptoms and signs sound as if they are improving.

Well at least the monograph says it's not a vesicant or irritant and treat extravasation/infiltration symptomatically. That's a positive. which You are doing.

Couldn't find anything that described any specifics for treament other than what the monograph below stated, whereas, some had lengthy descriptions of treament if infiltration/extravasation occur. Some were amazingly lengthy. All were for treatment immediately following infiltration/extravasation.  Your occurence is a week old Right?

The blistering was described that it could occur. Problem with blisters is the origin. Is it in response to the drug or is it a bacteria. Only culturing the fluid from a blister would tell.

The key is monitoring. Continue daily visits or if they have stopped daily visits and you are emailing daily pics, that will have them pick up condition change. You have seen at it's worst. That actually helps in moitoring, All the early s/s's indicated trouble. But they are gone now. My initial response was based on the fact that s/s's were still present. That's why all the questions above. Need to know if this is true?

The reason I keep using infiltration/ extravasation is --those are the terms used to describe a drug that is to be given IV , but moves into the tissues b/c the vessel ruptured for whatever reason. Halaven is indicated to be given IV only. So, for simplification that's why using these two terms is correct.

When a drug is to be      given IM or subcutaneous(subcu)--the espected is that infiltration/extravasation into the tissues  to be absorbed, is the goal of administration

The terms have a meaning that is a negative in one sense and intentional in the other,

C&P from monograph  between lines---------------------------------------------------------------------------------------------------

Good peripheral venous access or a patent central line should be ensured before administration.

There is no evidence that eribulin mesylate is a vesicant or an irritant. In the event of

extravasation, treatment should be symptomatic.

This document plus the full product monograph, prepared for

health professionals can be found by contacting the sponsor,

Eisai Limited, at: 1-877-873-4724.

This leaflet was prepared by Eisai Limited, Mississauga, ON

L4W 5A4.

Last revised: December 14, 2011

HALAVEN^TM is a trademark owned by Eisai R&D

Management Co., Ltd.

------------------------------------------------------------------------------------------------------------------------

If all the questions are showing that s/s's are improving, do as they say i.e continue to treat it symptomatically, as directed. Blisters that erupt like a volcano and little blisters occur around  the ruputed blisters in a circle. AND the little blisters grow until they rupture like a volano with little blisters around them, that's descriptive of a specific bacteria. Report this asap. Expected response would be a culture and sensitivity of fluid from a moist blister, a specific antibiotic started immediately until sensitivity report back(sensitivity reports are generated at 72 hours after culture).  An adjustment in the antibiotic treatment based on sensitivity report as necessary, is done at that time.

Report any condition change that shows worsening.

That I think covers all my thoughts. I will bump a thread I worked on a long time ago re: wound evaluation, care, and setting up an in home dressing station and bring the link here if I can. Good luck!

community.breastcancer.org/for...

sassy

2nd post to same member

member name deleted. To get to a wound care specialist almost universally you need a referral from a doc--your PCP may be faster to get to an appoitment with than the MO. Suggest that if you are in an immuncomprimised state to where a mask when going to a medical facility. Some would call this overeactive, I call it safe. Have you been able to read above post? I edited this am to add more detail and link. sassy--4 posts back

Edit: the halaven patietcare specialist response re: wound care specialist referral is the expected safe response from the company because it demonstrates on the recording of the call, that they recommended the highest standard of care available. Your PCP or MO may say no at this time to a referral based on wound presentation. I say this just in case they do say no, you will understand why, The PCP/MO are basing their response on direct visualization of the wound.

The PCP/MO may refer you ,even though their judgement of the wound doesn't warrant a refferal at this time. It falls in line with CYA. The PCP/MO can document they made a referral to the definitive highest level of care. Whatever their reasoning if you are referred, it will give you a sense of convidence that the wound has been evaluated by the most highly trained physician. Not just any doc can put up a shingle and call themselves a wound care specialist. They have to go through a special training program. Nurses in a wound care specialty center are also required to go through special training. The best nurses have the certifications from an accredited program. Emory University being the most well known on the eastern side of the country. Not sure what's available in the west. The Docs go to Cincinatti if a Bariatric chamber is part of the wound care centers treatment abilities. Too much detail . OCD lol sheila/sassy

RESPONSE TO MEMEBER POSTING REPONSE TO MEMBER QUESTION

MEMBER NAME RESPONDING TO MEMBER QUESTION DELETED-THIS IS MY RESPONSE TO HER:

 Can't attest to halaven because i haven't seen the label. But drugs carry that info on drug label. Clearly identified in mongraph I read this am. Clear. This nurse either was completely unfamilar with the drug---basic rule from nursing school NEVER GIVE A DRUG THAT YOU DON'T KNOW NAME/ACTION/ROUTE/.S.E/CONTRAINDICATIONS(NEVER USE)/DRUG INTERACTIONS/ALLERGIES.  OR SHE BREACHED A RULE OF ADMINISTRATION .I.E. SYRINGE NOT LABELED OR SHE HAD TWO SYRINGES AND MIXED THEM UP. ----bOLD BUTTON WON'T GO OFF. SORRY. AS EVERYONE HERE HAS SAID SHE SCREWED UP ROYALLY.

3RD RESPONSE TO MEMBER

MEMBER NAME DELETED- sorry, don't know how I didn't remember the references to bleeding. There were many--DUH.

In the post above I described the following, Ill try C&P (mouse cranky)

"you described a baseball size lump. that falls more into description of possible tissue reaction to the drug, abcess from the injection itself, Hematoma from hitting a blood vessel that ultimately sealed it self off.  What the body does is seal off an area in the occurence of anyone of the three." The other term used is wall it off. When there is drainage as you describe, it should have been cultured at first viewing by MO, because drainage may appear to be bloody when it actually is abcess fluid mixed with blood. It would look a dark reddish brown. The only way to know what the fluid was is the culture. Also when the body creates the wall around a hematoma or abcess it is hard as you described. In feeling/palpating the area. it would be referred to as abcess margin or wound margin. The wall protects the body from the fluid inside the the wall from entering the body. It will often spring a leak to the outside, that reduces the pressure on the wall. If it didn't spring this leak, the expanding fluid would rupture the wall internally.  The abcess fluid then can spread through other tissues and affect a wider area and or be absorbed into the systemic circulation. So, the leak to the outside is in a way a good thing. I kow your thinking right now. )(*^%$^&^&.  But better out than in. Treatment that you should expect is an INCISION and DRAINAGE--I&D that will allow for the release of the fluid inside the abcess. That is accomplished by knife puncture. Followed by two cultures--one for aerobic bacteria , the second for anaerobic bacteria. a drain placed to keep incision site open. Reclosure of the incision site would allow for a return to the original situation.

Your post describes bleeding/drainage has stopped. 

What you can expect

1.could be permanent -no further problem -fluid inside ultimately resolves over time,

<address></address><address>2. pressure of fluid inside springs a leak to the outside--s/s's increase in pain and pressure if fluid is building up again, reopening to outside should not have the same pain as #3 because the drainage tract is not healed. It's like a patch on a tire, not as strong as the tire-------seek physician intervention</address>

3. wound ruptures internally and fluid spreads through tissue.---s/s's(sign/syptoms). increasing pain  and  pressure  at the site. sudden stark icrease at rupture and reduction of pain and pressure.----seek physician intervention.

Options

1.Definitive person to do I&D is a surgeon b/c they will decide if abcess needs 1.surgical removal and debridment(cleaning out). 2.simple I&D. Your Breast surgeon is competent to do this.

2.PCP can , but likely would send you to ER or surgeon.

3.ER-- the examining physician is competent to perform an I&D, but would likely call the surgeon on call, they would consult regarding ER doc's findings. Between them they would decide if ER doc performs I&D or surgeon comes in.

4.If ER doc does I&D or PCP they likely will refer you to surgeon or the wound care center for further evaluation. Put on a broad spectrum antibiotic as I described above send you home with instructions. Those instructions would include "If condition changes or worsen, call doc on call or return to ER.

5.The other determination is that you would be admitted for IV antibiotics. If this is the determination they would put you in wound percautions isolation. This is appropriate. But you are also immunocomprimised. SO, you would have to ask for Revese Isolation too. The steps for each are just wee bit different

     a.Wound percautions protect teh staff and environment(door to roo) from contamination from wound.

      b.Reverse Isolation protects you, from staff and outside environment (door to room).

So, if you are admitted you need to be in wound and reverse isolation.(They may not agree to reverse isolation if your numbers are good).

So, the post of yesterday where I described in much shorter terms, compared  to what I have done now, described in minute detail ad nauseum, that I asked to bedelete. I now with complete info return to that recommendation. Of couse, it's now after 5pm on Friday.

If you go to ER, call ahead and use these word'" Immunocomprimised oncology patient coming in for evaluation of wound and needs reverse isolation.", They will put you into revese isolation , draw labs--CBC, check neutrophil and wbc count. Likely do blood cultures while drawing CBC. A second set of lab cultures would be drawn from a different site in 15 minutes. Your port would be one site(likely) and arm the other.

The completeness of this is not meant to scare you, but prepare you. With knowledge we can better understand the course of events. I'll watch for a post back. sheila/sassy

 4th Response to memeber asking question

There are some typos and punctuation errors. but mouse misbehaving. Rather than really screwing up post, I will leave them alone.

I am going to cut and paste these responses to the link I suggested above. I have used that link many times in similiar situatioms. It will delete your name. Everything that I have written to you is applicable to others in the same or similar situation. 

Good luck. sheila/sassy

sas-schatzi

Good Morning-friends, have been working on an issue with a member. Wanted to share with you all the note below b/c of it's importance. Hope you find it useful Sassy

(members name deleted) Glad the link helped. If you get the AARP magazine this months issue (probably dated may 2013) , there is a story about the safest hospitals and what safety procedures that are in place that cause them to be safe. The article cites that 180,000 people die a year due to medical/surgical errors AND 400,000 drug errors are made a year. The articles states that these numbers are likely higher b/c these are the ones that are reported. I agree. I know you've seen where I've said on the threads "Sorry etc for too much info, just want too make you(BCO memebers) safer". Guess I should stop apologizing for writing stuff in this regard. These numbers are higher then the last set of numbers that I had known. The problem is either getting worse OR there is better reporting. I'll go with better reporting.

It cited that one of the safety items was having an ICU Intensivist. It cited that only 35% of hospitals had Intensivist. I was dismayed at this percentage since residencies for Critical Care Medicine have been available since the 1980's. Truly thought by now that the "industry" would have been driven by demand for better care that this statistic would be 70 to 80%. ICU medicine is absolutely in need of a specially trained doc. Just as in all subspecialties of the American Medical Association(AMA), the knowledge and skills of this subspecialty are critical to survival when a patient is at this level of need.

I'm going to post this on the threads, I'll take off identifiers. My hope is those seeing this will locate a copy of the AARP article. Read it throroughly. Then question there local hospitals on each item. Based on what they elicit re:safety of each facility, they can choose the safest hospital near them for care. It can mean the difference between life and death, and or avoidable complications. Spreading the word to others regarding this may save lives.

Your description of where your friends daughter is now is typical. So, the care may have been fine or she recovered in spite of them. I'll go with the care b/c of your description of how she appears now. What was truly lacking here was the communication in lay terms to the family of was what was going on with the patient. All the lay person then can do observing is assume, as in this patients case, there appeared to be fractured care delivery and choas. What can the untrained person concluded observing this. As in all care, communication is the center of it all. Very often even the care givers question what the recovery will be. AND then the patient pulls through. Continuing with evaluating the records will lend a lot to the understanding of this event.

sas-schatzi

Bump-----their may be value in the posts here for those with wound problems sas

Galsal

Thanks for bringing this thread to my attention, Sas.  Wish I'd seen it before last week since there was an open wound with HH involved.  Regardless, it's been seriously helpful and today is the post-op appt after Friday's surgery.

The most interesting part was about a wound that has leakage - surgery last month had the leakage since no drain was used.  So it set things up for the capsulated seroma that happened. 

This time there is a drain although the output has been minimal.

sas-schatzi

Galsal, Glad the link on wound care helped. It isn't my thread, but I did allot of work on it. Happy to hear you had better results with the surgery Hugs old friend

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Hi reposting this on some threads, may be old news to some, but to good of info not to pass this on,Sassy

Bluebird144…NJJoined: Apr 2013Posts: 393

13 hours agoBluebird144 wrote:

Knitted Knockers Charities is a non-profit that exists to provide free patterns for knitters and crocheters to be able to make knockers and help mastectomy patients get freeKnitted Knockers made by volunteers.

I love my Knitted Knockers! They are light and soft and warm. Unlike my silicone prosthetic which is heavy and cold when first worn, then it later causes me to sweat.

I wear my knitted knockers inside a regular bra or tucked in the pocket of a mastectomy bra. They are beautiful, and a godsend to those of us with an uneven mastectomy scar.

Knitted knockers website:

http://www.knittedknockers.info/

Fall down seven times, stand up eight.

Surgery 09/09/2009 Prophylactic Ovary Removal (Both)Chemotherapy 02/06/2013 Adriamycin, Cytoxan, TaxolSurgery 07/19/2013 Mastectomy (Both); Lymph Node Removal: Sentinel Lymph Node Dissection, Axillary Lymph Node Dissection (Left); Reconstruction: DIEP flap (Both)Surgery 08/20/2013 Reconstruction (Right)Surgery 08/28/2013 Mastectomy (Right)Radiation Therapy 10/14/2013 3-D conformal external beam radiationSurgery 01/24/2014 Reconstruction: Tissue expander placement (Right)

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Bump, particular useful things here are wound care

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Bump, particular useful things here are wound care

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