Open wounds after surgery, sadness, depression, and guilt

Susie02

I am BRCA2+, have had a prophylactic hysterectomy, and just had a prophylactic double mastectomy a month ago. I feel extremely blessed! Because of some stressful events that have/are occurring in my life, I talked with my surgeon about delaying my surgery. He advised me to move forward with it, and thank goodness!!! because the pathology report found DCIS.

My plastic surgeon performed a "drawstring closure" where the aeroela/nipple would normally be. Well, all of that skin had to be debreed and I have been treating those open wounds (that look like craters) with wet/dry dressings for two weeks. I cry every morning when I have to re-dress the wounds (because they look so horrible and I have such a long time til they close) and Iam SO worried about infection. I can tell it is going to be a long process!

When I am able, all I want to do is rest/sleep. I am exhausted! I have a wonderful, helpful family and friends. Then, I feel guilty because I know there are people who are going through so much worse. And, I feel guilt because I don't feel like doing anything when I am not at work.

Anyone who has felt this way?

Thanks in advance for any insight or support.

Dallas7

My daughter had sepsis and the wound on her leg is open. She will be having a second skin graft in about 1 month. Although she is not a bc person, I understand your pain becuz I have a recuurence of bc after 12 years. I will have a mastecomy on my right breast in April. I forgot to mention the bc is also located in my left lymp node and I will have this removed also. I am praying that God will restore and sustain me. May God Bless you.

Mckaylaleigh

Susie, I am 2 weeks out (tomorrow) from my BMX.  Last week I found myself feeling much like you! I was not expecting it at all but many women on my March 16 surgeries forum assured me that it is fairly common.  I don't know much about what you are dealing with (never even heard of it before so I had to Google), but I can only imagine how having that on top of everything else would take it's toll! As everyone has been telling me, you just need to take the time you need and not feel guilty or bad about it. Hang in there!! HUGS!

Kelly

mustlovepoodles

i completely understand! My BMX was 2/4/16 and I experienced the same thing. It has been the most horrifying thing--it looks like a wolf tore a huge bite out of my chest. Ive been a nurse for 39 years and I've never seen anything like this. Thank God that I didn't have reconstruction or I would have lost it all. After using wet-to-dry dressings for a week, my PS put a wound vac on it. Ive had that for 4weeks and it looks better. The machine itself is a PITA.

The other side is also not healing well. It's got a deep pocket that's still draing and I have to pack it twice a day. Good times...

Believe me, this is NOT what I signed up for! I feel totally mutilated. In fact, I was even diagnosed with PTSD about 2 weeks ago! These wounds will probably not be fully healed until mid-May/early June.

Best of luck to you. Don't be afraid to speak up to your doctor about your feelings. I think under the circumstances anyone would be distressed and depressed.

ShetlandPony

Oh my gosh, Susie. You have been through major surgeries and are dealing with a very difficult situation. Your body and your spirit need to recover from the trauma. Now is the time to heal, physically and emotionally. Let yourself rest as much as possible. No guilt! Be kind to yourself.

Best wishes for every kind of healing to you Susie, Dallas and daughter, Kelly, and Poodles.

Chicagogal39

I feel the same way. I had a bilateral mastectomy 10 days ago and am having trouble with the skin healing - I'm using a silver cream twice a day and keeping a dressing on the wounds, but cry every time I do it, it looks so terrible. This too shall pass. Sending you strength.

Susie02

Sincere thanks to you all for sharing.

I pray for you who are in similar situations!

Journey2014

mustlovepoodles - Hi, sorry to hear about your open wound. I have an open wound as well due to radiated skin. They have to take out my tissue expander on the left chest (radiated side) and kept the tissue expander on my right breast. Right now I am packing it with silvercel once a day everyday. My plastic surgeon told me that it is better not to saw close it back up because the infection will set in before it will heal, his suggestion is to let it heal on it's own. I know it will take sometime before it looks normal since the wound is deep.

mustlovepoodles

Yep, MVP. I'm going down the same path, just a few weeks ahead of you. I finally, just this week, have been able to stop dressing the gaping wound. After 12 weeks, that wound has granulated in and no longer weeping. it will take a very long time for it to fill out and look okay. The scarring will be very bad. The other side still has a pocket, but it is much smaller. Just yesterday I stopped packing it--I could only get about 3" of packing in there, so it's just about closed. It just needs a small dressing on it. Both wounds have really come a long way and I am sooooo very glad to get to the end of this. At this point, I am not planning to have any recon, mostly due to the terrible experiences I've had with the BMX. But we'll see in a year. I might feel differently by then.

macb04

Surgery is well known to deplete Vitamin C. Sufficient Vitamin C is necessary for wound healing/collagen formation and wound strength. Vitamin C is also crucial for immunity. Most people do not get enough Vitamin C for one reason or another, so titrate your intake to bowel tolerance. Since Vitamin C is water soluble, you can not overdose on it, unless you have bowel or kidney issues. The amount of Vitamin C a person needs is dependent on their health/physiologic stressors, so if you have a cold you might need between 2 to 5 grams of Vitamin C per day, but if you are well, you might only need 1 gram per day. The bowel tolerance part of the equation is that when you have reached the maximum amount that your body needs of Vitamin C per day, you will get loose stools. The idea is that gradually over time as you get well, you will need less and less Vitamin C. Also Zinc is very helpful for wound healing, perhaps a good multivitamin as well as making sure to get plenty of vegetables and some fruits.

Hope some of this information is of help, you will get better.

http://www.ncbi.nlm.nih.gov/pubmed/7038579

Oral Surg Oral Med Oral Pathol. 1982 Mar;53(3):231-6.

Vitamin C and human wound healing.

Ringsdorf WM Jr, Cheraskin E.

Abstract

Clinical studies provide evidence that wound healing in subjects judged not deficient In Vitamin C can be significantly accelerated with supplements of this nutrient above the recommended daily allowance (RDA). The authors administered daily dosages of 500 to 3,000 mg., which is roughly 8 to 50 times the RDA of 60 mg., to subjects recovering from surgery, other injuries, decubital ulcers, and leg ulcers induced by hemolytic anemia. Genetic impairment of collagen synthesis has also been observed to be responsive toascorbic acid supplementation in an 8-year-old boy with Type VI Ehlers-Danlos syndrome. Four grams of ascorbic acid daily produced a significant improvement in the quality of newly synthesized collagen but did not alter that formed prior to the supplementation of C. The combined evidence in this review provides a substantial base for further research, both clinical and experimental trials, concerning the interrelationships between vitamin C and the body's healing potential.

PMID:

7038579

[PubMed - indexed for MEDLINE]

Healing the wounds or having surgery? Don't forget the Vitamin C! Dr Rath Research Institute, Santa Clara, California, USA Many ugly malformations of scar tissues or prolonged and complicated recoveries from surgical procedures can be avoided by the simple measure of taking the right vitamins. This is not new knowledge however. As long ago as 1937, Harvard Medical School surgeons observed the importance of vitamin C for wound healing in patients recovering from surgeries [1]. These physicians noted that "spontaneous breakdown of a surgical wound in the absence of infection occurs with relative frequency in patients with the cachexia of cancer, in debilitated individuals, and in young patients; notably those who have some congenital anomaly of the gastro-intestinal tract." Therefore, their recommendation for the administration of vitamin C was based on their subsequent observations that wound healing becomes faulty with low vitamin C, and that vitamin C levels were low in their patients. While such information remains pertinent today, it may be omitted in medical practice as routine protocols take precedent in the clinic. Recently we have received reports from nurses and practitioners whose patients' wounds will not heal despite the lack of complications. These practitioners even speculated that it may be a vitamin C deficiency or other malnutrition that is responsible for the slow wound healing. However, they admitted that some of their patients, frightened by the media vitamin scares, were hesitant to take supplements without scientific evidence of their beneficial effects. Therefore, it should benefit medical practitioners, their patients and the public at large to revisit these dusty old papers and new data explaining the role of vitamin C and nutrition in wound healing. Collagen – a fabric of our body When wounds heal, the body's metabolic requirements increase. In the first few days following a major injury or surgery, the body's vitamin C may fall to dramatically low levels. In one hospital study, the vitamin C levels of critically injured patients were uniformly at severe scurvy levels [2]. Only high doses (multi-gram) of vitamin C, but not milligram amounts, were effective in restoring blood levels for this vitamin back to normal. Why is it so important to re-supplement vitamin C? Without an additional supply of vitamin C, the formation of new replacement connective tissue between cells is hindered and the new tissue formed to close the wound may be fragile, defective, or missing altogether. The majority of this connective tissue is collagen, which is comprised of the amino acids lysine, proline, and glycine assembled together in molecular cables and sheets. These collagen cables and sheets are the structural beams, walls, and scaffolding of the body's cells that must be repaired and rebuilt in the case of an injury. Even the seemingly inorganic bones of the body are comprised of a finely organized structure of collagen cables between which mineral is laid down. The enzymes critical to forming these cables of collagen between our cells cannot function without its co-factor vitamin C [3]. Likewise, lysine and proline are necessary structural elements of collagen that are required to a higher degree at the site of wound healing. Lysine is an essential amino acid that humans cannot produce and it must be supplied by the diet. While humans can manufacture their own proline, the rate at which they make it may decrease under illness. A wound patient may utilize as much as 100 grams of protein a day, and their requirements for supplemental amino acids such as lysine and proline may be very high [4]. It follows that a deficiency of lysine or proline would also prevent proper wound healing as these are the raw materials for making connective tissue. Wound healing requires a team effort Not only are vitamin C, lysine, and proline essential to the rebuilding of damaged tissues, but also a variety of macro- and micro-nutrients that supply bio-energy, building blocks, and enzymatic cofactors needed by the cells to maintain all their normal tasks. As the rebuilding process involves the immune system to clear out damaged debris and infectious agents, new cells divide and move in to replace lost cells. All cells then work together in forming a bed of collagen, fibronectin, laminin, proteoglycans, and other extracellular matrix molecules that give a functional form and structure, without which the tissues of the body would disintegrate. All of these processes involve an intricate cascade of interdependent biochemical events within each and every cell, and each of these processes has a different nutritional requirement. Although there is not much economic interest in funding studies with micronutrients in wound healing, there is enough clinical evidence in support of micronutrient supplementation. The clinical study developed and sponsored by Dr Rath Research Institute demonstrated that daily supplementation with the collagen building nutrients such as vitamin C, lysine and proline, significantly accelerated healing of bone fractures [5]. This study confirmed the critical role of bone collagen for faster bone healing since these patients were not taking calcium supplements, commonly recommended in bone health. Healthy bone metabolism requires both collagen building micronutrients and minerals. Also, our laboratory data have proven that synergy of vitamin C, lysine, proline, green tea extract, arginine and other micronutrients aids in healing skin wounds and reduces scar tissue (unpublished). Therefore, the keen observation of today's bedside caregivers that wounds may be slow to heal because of micronutrient deficiencies and malnutrition is correct and applies not only to patients in developing countries, but to patients in hospitals in Berlin, Paris, Warsaw, or San Francisco. Micronutrients deficiencies are still common and affect both young and old. Therefore, a simple measure like taking nutritional supplements can help in mending our cuts, wounds, burns, broken bones and surgically damaged tissues without health risks. At what cost? Less than the price of the cup of coffee you buy at Starbucks every day. References: [1] Lanman, T.H., Ingalls, T.H. (1937) Vitamin C deficiency and wound healing: an experimental and clinical study. Annals of Surgery 105(4): 616-625. [2] Long, C.L., Maull K.I., et al. (2003) Ascorbic acid dynamics in the seriously ill and injured. J Surg Res 109(2): 144-148. [3] Berg, R.A., Steinmann, B., et al. (1983) Ascorbate deficiency results in decreased collagen production: under-hydroxylation of proline leads to increased intracellular degradation. Arch Biochem Biophys 226(2): 681-686. [4] Russell L. (2001) The importance of patients' nutritional status in wound healing. Br J Nurs 10(6 Suppl):S42, S44-S49 [5] J. Jamdar, B.Rao, et al (2004), Reduction in Tibial Shaft Fracture Healing Time with Essential Nutrient Supplementation Containing Ascorbic Acid, Lysine and Proline, Journal of Alternative and Complementary Medicine, 10, 915-916.