Skin / Capillaries look dead to surgeon

Hello, my mom had her nipple sparing mastectomy with immediate reconstruction June 28. She is going to have another surgery this Saturday because she has diabetes with the Dr. Says is causing small veins which can't reach all the skin he left (she has big breasts) and slows down healing. The surgery this Saturday is to remove the infecteD or dead skin. Has anyone else had problems with their mastectomy like this? What should her skin look like? Right now it is a bruised dark red in some spots, black dry, a slimy yellow and normal in other spots? She was only on antibiotics for a week and had her drains in for about two weeks. The Doctor started having us change her bandages daily a week after thE surgery but it didn't help. We were applying the silverdene but only told to wipe down with a clean warm damp washcloth, apply vaseline bandages, n gauze. Does reconstruction just not take in some people especially diabetics? Any insight would be appreciated.

Marichai, hope all goes well tomorrow with the debridement. Please read the posts on page one re: homehealth care. There are three. She is an excellent candidate for this service. Docs need to be reminded that it's available. Be her advocate. It is difficult to be your mom's caretaker without guidance. The HH nurse can help get things going for you. Your mom has the additional challenge of diabetes. She will need close monitoring of her blood sugars and diet. Again the HHnurse can help setup a plan for this, and teach you about her meds and insulin injections if she is on them. Ask for HHnurse, physical therapy , and occupational therapy. Try to have all caretakers there for first and second visit of each discipline(nurse,PT,OT), But at least one family member will do. Most of first nurse visit is admission material--paperwork, and dressing change. PT will do a test of her physical strength , balance, and endurance. OT will evaluate her ability to care for herself. All will make recommendations related to their expertise, as well as safety recommendatios.

Why you want to be there. Ask them to teach you the proper way to do things to care for her. LIsten as they teach her and then you can follow through with the teaching and feel more secure each day. Be their for the dressing changes, and the nurse will teach you. One of the biggest aspects of HH is teaching. So, don't be afraid or hesitate to ask questions. It's expected.

If after you learned the dressing care and the frequency of the nurse visits decrease, you observe a change in the incisional area. You can call your nurse and she will visit to evaluate the situation and make recommendations. It can be something as simple as not putting a dressing on too tight, to recommending she be evaluated by her doc, or tell you to take her to the emergency room, or call the EMS number in your country. It can give you great peace of mind. The primary goal in HH is to keep the patient safely in the home, properly cared for, and return to pre-event health.

Not sure what time zone you are in, but it is sunday 17th, 2010. Your mom should be on her first post op day. if she is already home and HH referrals haven't been made, call docs office first thing Monday morning and ask for the referral to be made . The office will take it from there. As a back up call the docs office one hour before closing to verify the refferal has been made. good luck, sas

   

Maricha,  glad things went well. I know it has been a great relief to all of you. VAC therapy is one of the best inventions of this last decade. It has radically improved wound care. Greatest improvement maybe ever, when used properly.

I would suggest, Monday morning(see below) to still ask for HH. The nurse can still see your mom on the days she is not seen by the doctor. Plus, with the VAC-- it is a machine. If something goes wrong with it, you have the nurse to call for help. Rememeber mom has the additional challenge of diabetes. The HH nurse can give great guidance and teaching in this regard. Again, she can see how your mom has been managing in her own home. She can assess and correct any areas discovered that she doesn't know about this disease process. Having PT come in and doing the in home eval. has great value because they can observe her in her own environment and don't forget they can make the safety rec's that Native Mariner described in page one. Something as "simple" as grab bars can take days to accomplish because of acquistion and installation. Grab bars need to be placed in the proper position, they shouldn't just be put up. They need a trained eye to describe where they should be placed.

The nurse visits in this instance will be few until the VAC comes out, but then the doc may want to turn the dressing changes over to the nurse in the home with mom being seen by the doc once a week or once every other week. If the nurse is already in the home the transition will be seemless i.e. smooth.  Again, if your not taught the proper handling of dressings what do you do when one falls off. You want to know that you are able to change the dressing without contaminating the wound. Set aside an area as a dressing station where all supplies are kept. and covered as described on page one. 

The best time to start the process for discharge is on the same day as admission. In this case, Monday morning ask to speak to the Discharge planner. She will guide you through the process. Check briefly daily to see how things are going. i.e. insurance approval etc. The worst time to start discharge planning is at discharge. Anyone who has had this experience, the only word to describe it is ---chaos.

Good luck, please don't hesitate to come back here with your questions ----sas

Dear Sas

 Thank you thank you thank you for all the wonderful information.  I will be sure to get to work on everything you wrote.  I feel really optimistic about the VAC and her healing properly this time especially if she has a Home Health Nurse to change dressings after the VAC.

 Thank you I will keep you posted,

Marichai

SAS,

As requested I have posted our chats. Hope this is helpful for folks if they are going through the same thing.

sas-schatzi said:

Mari,  How are things progressing? I rethought my response re: the credit card statement because in rereading I thought if I were reading it from your point of view I would be offended.  I edited my response and I hope you go back and read the edited response. I apologize if i gave any offense. I as well thought, when I wrote it it would be great if someone issued a low interest rate card for all cancer patients.

Hope things are progressing well with your mom. I understand only to well what you are going through in trying to take care of her needs. I took care of my mom ,dad , a dear aunt and now my husband.  You can drown when you don't know what to expect. You learn to look at friday 5pm with trepidation because you can't get anything done until monday. AND if something changes in your loved ones condition , your resource maybe ER vs your doc of choice. Which does bring to mind a few other suggestions. Rather than write them here I'll go back on the thread. of Just diagnosed _get prepared. Thanks for bringing the memories back. Again I apologise if I gave any offense. -sas

Hey Sas,

Well things are kinda starting to get stressful it seems. Don't worry about your reply regarding the credit card.  I didn't think the response was offensive at all.  I haven't read the edited response yet but I will, promise.

Yesterday night the wound VAC wasn't working and I had to remove it and place gauze on it. I wasn't very calm during the whole process and stressed my mom out.  Also the Dr says she will be out for another 4 weeks from work and I'm worried that she will run out of FMLA which only gives you 12 weeks (she already has 4 weeks out). So that means she would lose her insurance. I realize we could get the COBRA insurance going after she is let go but it would be nice if we didn't have to do that.

The Dr doesn't think it's necessary to get a home health nurse because she isn't restricted to home she goes out to the store ever so often. I haven't started anything on Social Security but my mom doesn't want me to because she says they will ask about savings n all.  She thinks we should use that as an absolute last resort.

 My sister and I take my mom to the Dr's appointments and apparently we haven't been communicating every detail. At my mom's last wound change they were suppose to put foam inside of the wound to keep it from fusing together to help with reconstruction/expander/implant. Well they didn't and my sister was pretty upset and thought it was my fault for not picking up that detail in the voice recording she sent me. So yea we are on the verge of drowning. Now I'm thinking maybe it wasn't such a good idea to do the immediate reconstruction because we don't even know if she will need radiation which could damage the skin anyway and ruin the reconstruction. The surgeons didn't think she would need chemo or radiation but I finally decided to set up a consult with the oncologist even though the plastic surgeon said she couldn't do that yet until she heals.

I hope this isn't too much to dump on you, but I needed to vent and write this out. There is no obligation to respond just needed to vent.

Thanks so much for listening,

Mari

sas-schatzi said:

 Mari, so glad you weren't offended. Good.

I wish this was posted on the skin/cap thread, because it points out why there should be homehealth. With HH you have to be homebound if you are under medicare. But medicare allows you to go to doc visits, church, bank, grocery, hairdresser. With commercial insurance they probably each have their own rules. Mine I would actually go to their place of employment. PC WRONG. Didn't mean to hit caps , but take it as a sign.

Social security  application----We can't predict the future, if I had a do over, I would have applied from day one.They don't ask about savings or mutual funds. All they are interested in is your tax return from previous year. Start now if you become concerned you can stop the process.

I didn't say on the thread because I didn't want to overstep bounds. Frankly, I can't believe that an Onc is not involved. They are usually involved day one of dx. Yours is the only case I've heard of where they haven't been. WRONG WRONG WRONG.  Get ONC as you are doing asap. Mari I hate to ask you to repost on the thread because it's alot of work. I know I'm a two finger typer that has to look at the keyboard to find keys. BUT where are you located that a surgeon and PS don't want to know plan of ONC and are proceeding with everything without a plan is unheard of--unconscionable(SIC)

Your sister is wrong. Neither of you should have to know when a sponge should be placed. The person doing the dressing change made an ERROR BIG TIME.They are supposed to be following doctors written orders. I suggest you take it to the highest authority of the bluiding you were in, and to the parent facility.  This is a big deal-- trust me--Big ERROR

Please tell me moms age.  Tell me your location.  city/state. Repost on thread. I wish there was a way to transfer this , but i don't know if there is. There is too much here that should be shared with everyone.

Look at BCO's main page it has a section that talks about work and job and FMLA. It is a must rea

Mari I wouldn't be doing this if I didn't think I could help. WE had two cancers in one house last year ---reread the top part of my thread post. We have regretfully learned to much about failures within the system. I added a whole post on things that would be helpful to you and your sister. I was POA for three people. It's work and tiring and daunting and mind blowing and awful when unprepared. All of which I had to learn as time went on and problems occurred----I had no guide. Please get your sis to read this PM and the thread.

Again can't believe no ONC involved ---ERROR -----

YOU have my permission to print this out and share it with her.   sas

marichai22 said:

Sas,

Thank you for your reply. As always you are so so helpful. Thank God for you and your posts. I would love to repost this. I was just afraid to shock, panic, or scare anyone. I have a tendency to not have any tact and just blab whatever frantic thing I'm panicking about that day and it has scared and even offended people in the past. Should I just copy and paste the whole message from the beginning? I agree it would allow folks to learn from our mistakes so they don't have to run into the same chaotic mishaps.  My mom is 53 years old she lives in Cheyenne, Wyoming. She doesn't currently have Medicare just health insurance but I think your right I will start the SS application.  I'm going to read the FMLA information on BCO website right now. Lot of things to do. I'm glad I got the ONC appt. set up. I think you are so so right it would have been nice to have the ONCO on board from the beginning it would have been nice to get a clear picture so we knew how to plan everything out.

Thanks,

Mari

 Mari, Attempt a cut and paste I don't know if it will work. Do the same to my reply. I can always edit on site. If you want to edit out where your location is thats fine, actually --do it-instinct. Coming to BCO when we are panicked, worried, unsure is a big finction of the site. We help each other. AND you never know when your problem is also someonelses problem. Your talking to people that have lived through it. I think there is a thread for family caregivers such as yourself, not sure how to find it. Has your sister started coming here. It may help her also.

I still don't get the fact that no Onc involved. It's going to be interesting to hear what he/she has tho say when you were told they weren't needed. I bet it stirs up a hornets nest. As, I beleive it should. You won't be privey to that because it's going to happen behind closed doors. Find out if the Onc has priveleges at the same hospital as surgeon and PS.

I have already edited my PM to you so you are good to go to try cut and paste.

bump

CrunchyPoodleMama-  I am so glad you posted this.  I am having my TE put back in on March 10th after it failed the first time.  I am gonna ask my PS about this for sure.  Thanks so much for the info.  Glad to hear you are doing well.

I will do that for sure. Thanks again.

bump again

HOLD ON FOLKS------ANY SUPPLEMENT TAKING NEEDS TO BE APPROVED BY YOUR DOC- NOTHING THAT I HAVE WRITTEN HERE WAS WITHOUT STANDARD NURSING TRAINING OR SUPPORTED BY PEER REVIEWED ARTICLES OR CLEARLY IDENTIFIED THAT IT HAD NO PREVIOUS STUDIES. THIS IS REALLY IMPORTANT.
EITHER IDENTIFY SOMETHING AS ANECDOTAL-----MEANING NOT RESEARCHED WHICH I HAVE  OR IF IT IS RESEARCHED QUOTE THE PEER REVIEWED ARTICLE.

THE BEGINNING OF THIS THREAD DEALT WITH WOUND CARE ----NOT SUPPLEMENTS. PLEASE TAKE THAT DISCUSSION  OF SUPPLEMENTS TO  THAT THREAD SITE

I don't want to mix apples and oranges thanks, sheila

May9th 2011----------This post was written Feb 28, 2011 01:05 pm, edited 24 minutes ago by sas-schatzi sas-schatzi wrote:

Edit: this post was deleted in it's entirety on 12/28/12. I was using it to help another member. I had to edit it so much it wasn't useful any more in the shape it was in. The BCO community is better served by a substitution of the following information. Thanks sheila

Chevy this is a post to someonelse that has referrences to diluted bleach baths I found during my horror from hell infection. The bacteria I had made MRSA look tame. I was AGHAST! With your skin condition, do what I first recommended i.e back to the derm doc for a biopsy. They will either do scrappings or a "punch" biopsy. Either way the next test is a look under the microscope as well as doing a C&S. Don't consider the diluted bleach baths until this is done. Secondly, you MUST read the research PLEASE. This is serious business, you must determine if you meet the criteria as identified in the Pediatric Journal article.

Revised my recommendation. Do as above, take articles with you and get your doc's okay for bleach baths.

I'm done reviewing the material and fixing the links. Some originally sited articles I couldn't locate. What's happened is there has been an explosion of info on the subject. What in 2009 was considered quite controversial, has turned into standard practice. There are sooooo many articles now, you can pick and choose. Google Keywords:eczema, MRSA and bleach baths.

The links address Chevy's concern re treatment of her eczema and everyones concern re: CA-MRSA.  Ta DA--two for one-- cool.

http://community.breastcancer.org/forum/44/topic/753120?page=73#idx_2184

Anyone having trouble with bra fittings and migrating foobs, this is the site you want to go too. Amazing information.  Will be back want to post this on some other sites ) sheila

http://community.breastcancer.org/forum/78/topic/770796?page=1

New thread on Hotflashes -------lots of good suggestions.

Shortlady-----what name product did you use. If consumer report recommended it, I'd like to give it a try. Protein powder should be used carefully by anyone with kidney trouble. Shortlady you definitely don't sound like your using it to excess. My diet sux's no appetite. So, not eating right. Thanks shortlady for adding this info. Anyone using a protein powder should check with their doc first. And know that their kidney function is normal.

New thread on social security questions answered by a lawyer whose wife has BC. Knows his stuff------posting on a bunch of threads---------go to financial forum

 Can't make link work without trouble, not up for it.