Wound Vac

Steph99

Anyone go home with a wound vac from surgery?

Thanks, Steph

Janett2014

I didn't, but my husband had a wound vac after a post-surgery infection. The surgery was to remove a stage 2, grade 3 sarcoma. The wound vac wasn't too convenient since it has to be on 24/7 except for showering. It did however REALLY speed up his healing. The wound care docs were very impressed with his progress. We were too! It was definitely worth the bother.

Have they told you that you will have one? What type of surgery are you having?

sas-schatzi

Steph I wrote some stuff on wound vacs to this other member. Here's the link

https://community.breastcancer.org/forum/91/topic/832108?page=1#idx_12

This is another thread I did extensive wound care instructions hope you can find some useful info Sassy

https://community.breastcancer.org/forum/44/topic/754935?page=1

 

jcfree

In 2013 I had a blood clot in my left leg which required surgery to remove it. Developed complications and had to have another surgery on same leg. Went home with wound vac, had it on for 6 weeks. Not a pleasant experience, but it sure did the job. It healed faster and no problem with infection. Bandages had to be changed twice a week, had home health care nurses that came in and did that. Without the wound vac bandages would have to be changed daily and would take twice as long to heal. Definately was worth using the wound vac.

sbelizabeth

I went home with a wound vac after a revision surgery for recon.  It consisted of a sealed dressing over the wound, with tubing leading from the dressing to a machine that I carried around like a small shoulder purse.  I worked full time through it; the "home" health care nurse came to my office every other day to change the dressing.  It worked really well to close up the hole under my breast. 

Belinda977

My incision broke open after my lumptectomy. It definitely helped the healing so that I could start radiation. I would still walk several miles carrying the wound vac.

Steph99

I am having a mastectomy. I am triple negative with preliminary pathology favoring Metaplastic Breast Cancer but still a chance of being osteosarcoma in my breast. Stanford pathology recommended almost two months ago to remove for further dx. I go Monday for removal of entire breast including pectoralis major and minor and a few nodes with the sentinel node being done beforehand.

Steph

Steph99

Thank you sas-schatzi these are both very useful posts.

Steph

Steph99

Thanks all here for posting your experiences. When I first realized I'd be going home with this machine and basically a big hole in my chest I broke into tears but now that I've learned from others what the experience will be like and what it can do for me I'm glad they have decided to use it. Just not having to change the dressing as much is a big relief for one. I will let you know how it turns out. Excited to get this tumor out but scared at the same time.

Steph

sas-schatzi

Steph, i'm a retired nurse. If I can be of help, the offer is there. I have this in my favs I'll watch for your posts. Pming me might be a good thing if you need me

As you know your surgery is extensive. One suggestion is to ask about how they will manage your shoulder /arm range of motion. The older way is immbolization which leads to a frozen shoulder. With you being at Standford, my expectation is that they would be on the most current cutting edge management to limit shoulder problems. It would be nice to have a discussion re:this before hand.

Another suggestion: The ideal is that referral is sent beforehand vesus the day ofdischarge. Have HomeHealth referral in place ready to go as soon as you are sent home. The nurse is the first one in. In line with the shoulder discussion ask that a referral for home health physical therapy(PT) and occupational health therapy.(OT). OT 's name is not actually related to occupation. OT will show you how to mobilize the arm when it's time and how to do activities of daily living. Your going to be a winged bird for abit.

Following that train of thought do a house review. Look at walk ways and make sure furniture isn't in the way. I used to use a phrase: "Think how can this house hurt me", and then fix it . If possible have someone put a grab bar in the shower and have a shower chair. A detachable personal spray shower head is very nice in your scenario. All these thoughts are late now, but maybe you can pull in family friend resources to get them done.

It would be nice to have a nurses's aide the first 2-3 weeks to help with showers and bed changes. It's more difficult to get this service these days. 

I'll link to a pain thread I worked on. Look for the post on pain scale. I present it as it should be, not the smiley faces which was designed for kids. Take your pain medicine around the clock the first about 4 days. then take a break and evaluate pain. By taking your pain med on a scheduled basis you will stay ahead of the pain instead of trying to play catchup. This will make you much more comfortable physically and mentally. it will also be a positive to get you walking early.

Be back with links

sas-schatzi

Steph this is a link to a pain med thread. I didn't work on this one. Bestbird did a nice post on the newer opiod drugs. FYI in case they give you one of the newer drugs

https://community.breastcancer.org/forum/8/topic/830526?page=1#idx_24

sas-schatzi

Steph, This is a post on how to use the pain scale. Understanding the scale and how it translates to making decisions on how to manage pain allows you a measure of control

Jun 21, 2011 01:22 am sas-schatzi wrote:

. This is going to be long, sorry folks. Generic description of how to evaluate pain and what to do.

First try to see if comfort measures will change level of pain---positioning change> if you have been in on position too long that can cause muscle fatigue which can lead to pain. When appropriate try warming up or mild stretching or getting up and walk around. In the hospital The first thing after asking what when where why , how long etc to determined what I was dealing with,  I'd then look at, is something to tight restricting etc. If the patient has pushed things too much, too fast and pain is caused by overuse---rest.   Bottom line is figure out what we are dealing with first. If this fails  go to meds

Using the pain scale. Research has shown that the worst judges of a patients pain are doctors and nurses. The best judge of the patient pain is there own self description. Everyones tolerance of pain and response to pain is different. No one should assume that anyonelses pain is like their own. If they do, they are arrogant and ignorant of the in depth research of the last 25 years.  If you have somatic pain which is physical body pain----taking medication is appropriate.

I know allot of people mock the pain scale ,but with adequate explanation it works. This is how I used to present it. Zero --no pain, 1-3 is mild pain, generally tolerated well, but there are people that would like relief from that , so NSAIDS  like motrin ,advil, tylenol if tolerated usually work well.

4-5 and maybe 6 are moderate pain. The choice of pain reliever can be individual here too. Many people do not like taking a narcotic because of fear of getting hooked. So using the previously mentioned drugs are okay. Some people don't get relief with these drugs. So taking the lowest dose narcotic may be a better choice for this individual. Many of the narcotics are combined with the nsaids or tylenol. For example, tylenol 325 mg with oxycodone  5mg = percocet, tylenol 500mg + oyxcodone = Tylox, Hydrocone and tylenol 325mg =vicodin, Etc. Try one pill at lowest dose. If no relief or relief is not acceptable and the doc has said it's okay take the second one---do so.  The reason the drugs are combined is they hit different receptor site sand that will give more widespread relief.

7-10 is severe pain, if at home take the higher dose allowed and should expect pain level to decrease below at least a four or lower,  if no pain relief call doctor.

Don't exceed recommend doses without doctor being aware because it could be an indicator something serious is brewing.

NSAIDS and tylenol are not benign drugs. Taken in doses higher than recommended can cause damage to the liver and the kidney , that may not be reversible. NSAIDS and tylenol should never be taken with alcohol, because of this---Millions of people in the USA have done this for decades----many may have problems years later. Only in the last tens years has the damage that the NSAIDS/tylenol in combination with alcohol become known, But the public has not been adequately informed.

In the hospital at a 6 or higher, I always recommended IV pain meds because------>5- 6 you start to see changes in blood pressure and heart rate,  and chemicals are produced in the body that will actually interfere with healing.

If someone said "well my pains a 20 or 100". I would immediately contact the doc for a regimen change. For example, bone pain from neulasta I said" 100 and it feels like wolves gnawing at my bones and I'm alive" That's pretty descriptive that the meds weren't working.

 When we talk of emotional pain.  That's where the doc or counselor ought to be looking at drugs like the benzodiazapines>>>>>>xanax, valium, ativan. An evaluation for depression is appropriate because  there are many good drugs that will alleviate this and take care of the physical pain as well. When our bodies are under to much pain stress for too long, we can get into the "chronic widespread pain syndrome cycle" Abbreviated CWP. Previously known as and still known as fibromyalgia, but the seriousness of it has only recently been taken seriously and treated seriously. Drugs like Savella and cymbalta and lyrica are good for this, but they do take several weeks to do there magic. Think of it as a logjam. Taking one log away isn't going to get the river flowing. BUT in the meantime we need relief. So, a combination of drugs to relieve the emotional stress >>benzo's and the physical pain>>i.e percocet may be appropriate. 

So, we each have to evaluate which it is emotional or physical and take steps to make sure we are safe , but getting some relief. Do all the comfort measures possible>>massage, adequate sleep, adequate hydration(lack of proper hydration will cause the muscles to ache/pain and fatigue faster). Get our cancer docs to make proper referrals for the emotional pain---The best resource to get this moving in a cancer center is through the social worker that can work the system. Try and reduce narcotic pain relievers slowly, if we have  been on them a long time, our body is used to them.  If we reduce them to fast, we will go through withdrawal.

Re-posted from another thread ----hope you find something here that helps --sas

sas-schatzi

Steph, I guess I'm just going to be your private duty nurse LOL

This is a link to the constipation thread I started eons ago. Many members have offered solutions to the problem. After about pg 8 or so I reviewed all the responses. Stewed prunes and apricots were the most used and successful  along with the use of Senna..

Miralax is one of the biggest prescribed by GI doc's this decade. I am not a fan of Miralax because it says in the monograph not to be taken by someone with kidney problems. No where could I find more indepth discussion on this kidney caution. Polyethylene glycol-Miralax should be in the GI tract, the only way it could affect the kidney is if some was being absorbed. Better to avoid. Long term consequences are not known. I mention Miralax b/c it is so widely used by docs now.

Skim and scan as needed for a better go

https://community.breastcancer.org/forum/6/topic/781867?page=1

sas-schatzi

For your emotional health Warm and Fuzzies thread can give you some laughs during recovery

https://community.breastcancer.org/forum/102/topic/818346?page=1

This link is to You Know Your A Cancer Patient When--YKYACPW. It's all the ironies related to cancer that only we can truly understand.

https://community.breastcancer.org/forum/67/topic/755825?page=1

badger's "pink glove dance"

. http://www.youtube.com/watch?v=OEdVfyt-

 

sas-schatzi

Post-op hydration and progressive return to normal diet

Jul  2, 2011 05:53 PM, edited  Jul  5, 2011 08:17 AM  by sas-schatzi

Post -op hydration or the taking in of oral fluids is very important to avoid dehydration. That was discussed a couple of posts ago.

BUT solid food you have to be careful with. The meds used during surgery can slow down the working wave like motion of the intestinal tract. Introducing too much food, too fast post-op can cause the intestinal tract to go to sleep. The medical term is an ileus.  It's as if the intestine is saying "I'm not ready yet". You can avoid this problem post-op by starting first with clear liquids.

Clear liquids include anything you can see through--clear broths , jello, tea/coffee,Popsicles. If you tolerate the clear liquids i.e no nausea or vomiting,abd pain, bloating, burping, then you can move onto full liquids.

Full liquids include milk or anything made with milk --like ice cream,custards. If full liquids are tolerated, again no N/V-bloating, burping, then move to a soft low residue foods.

Soft low residue diet is easily digested and doesn't irritate the intestinal tract. The hyperlink below is a very complete listing of what is include on this diet-www.nlm.nih.gov/medlineplus/en...

Again , if there are no abdominal complaints----N/V, bloating, pain, burping, The BIGGEST question of all, is are you passing  gas from the rectum. This is important because it tells us the intestinal tract is awake and moving in the right direction-------Yeah  And a first bowel movement is to be applauded.

The exact amount of time at each level cannot be predicted. The key is no symptoms/ passing gas/ and bowel movement.

Time to move to a regular diet------this means there are no dietary/food restrictions. Start with small portions, and may be 4-5 small meals for a day or so.

sas-schatzi

Respiratory health post-op: No getting around it your chest is going to hurt. To prevent problems doing the following three activities will help to prevent respiratory problems.

1. Early ambulation allows for the full expansion of the lungs, also get's the circulation going and helps to prevent lower leg clots. A two for one activity.

2. Coughing and deep breathing: Best done while sitting at side of bed or standing to allow full lung expansion. Do in conjunction with incentive spirometer. Coughing is the forceful exhalation of air and secretions. Helps to keep the sacs open and clean the airways. Incorporate the coughing about 2-4 x's per hour.

3. Incentive spirometer: One of the best inventions of the last century. This isn't arrogant but......almost universally the instructions for use are wrong. It's kind of like the telephone game. The original instructions got changed along the way. I won't waste breath saying how they are wrong LOL just going to do the original instructions of when it was invented. A baseline should be established pre-op of what you can pull. Ideal, but usually not done. Positioning as above in #2. The exercise is to mimic sighing. Sighing normally occurs 10-12 times per hour--shoot for 10. This expands the small sacs of the lungs. Surgery or illness can reduce this normal process b/c of pain or weakness. The little sacs get sticky on themselves and can take an increased pressure to pop them open post-op. What's different about sucking in with the spirometer is the sacs can be better popped open if you suck in quickly versus a slow draw(usual instruction). 1-2 pulls per time maximum. Even respiratory will come in and try to have you do ten times at one session. It will work, but you will be light headed and out of breath. Again, it's mimicking sighing, when you sigh it's one at a time. You are going for volume. The greater the volume the greater the lung expansion. Look at the volume column. This goal of the exercise is to prevent pneumonia.

sas-schatzi

How to get out of bed: Two methods. Try to practice pre-op.

1. Post BMX I found that this worked the best and was quite surprised that it was better than log rolling. It has to do with the muscles. This is an assisted move. First, move body to side of bed, otherwise it's to stressful on helpers back. Have helper place their hand behind your head at the base and on the neck. You push against their hand and use your back muscles to raise your torso. The helper assists with the other hand on the legs to rotate you to an upright position.

2. logrolling: With Bmx no choice but to roll one way or the other. MX you want to position yourself for the roll on the unaffected (non-surgery) side. This is an unassisted move. (no helper around). First, turn on side. Not too close to edge so you don't roll out. The spine is straight. The next movements once body, legs and arms are set in position are all done at once. Keep torso in a straight position. The elbow of the bed level arm will push into the bed. The hand of the upper arm will push into the bed. The bed level foot is over the side and ready to push into the side of the bed. The upper foot pushes and moves on the side of the bed in a multiple small moves. To get to sitting position: perform all moves at the same time. If they're is a helper, they can assist by placing hand on the bed side of the neck and the legs to help with the up move. If the bed is soft i.e. memory foam, this will be very difficult to impossible to use this maneuver. If the first days you haven't a helper for each time you want to get out of bed, choose the firmer mattress in the house.

#2  move is ideal for abdominal and back surgery and can be done with or without a helper, but if you haven't a helper it's you go to maneuver.   #1 move has to have a helper.  I quickly found out post op that #1 move caused less pain than #2.

Bedside commode:

Last thing in the world any of us want to use. But with a wound vac and the extensive muscle removal, I highly suggest you have one. Position the commode at right angles to the bed. Choice of head or foot is yours. Consider where vac unit is sitting and that the commode can't prevent your legs from swinging out of bed. You want to be able to come to a sitting position stand and do a quarter turn and sit without getting tangled. We all like to think we can hold it. Post -op you will be peeing out all the fluids your body held onto through the surgery and first days post-op. Once the body starts dumping the fluid, it'll seem like you had a diuretic or several beers. Your surgery is different  b/c of the amount of muscle being removed. You are not going to move as fast as a less extensive surgery.

Okay Steph--With the links and posts, we have covered all the pre-op teaching I would do with a patient.

Scarlett152

I had a wound vac for a skin graft after the nipple and areola necrossed post DIEP flap. I had the portable one and although it was advertised as "virtually silent" get some earplugs to sleep through the night. Also, the smell of the dressing material bothered me. Rather toxic smelling foam. Other than that, it was nice not to have to dress the wound twice a day as I was doing before. It healed quite nicely and it was off in 10 days. Now waiting for a revision and possibly a nipple sharing graft or tattoo, but that'sdown the road a year or so.

Good luck!

sas-schatzi

Steph's surgery is today.