Documenting dressings, Beginning HBO

I was thinking about my nine+ years of treatment and the optimism I’ve carried all these years (most of the time). I named my first blog “The Intensive Interferon Experience” because I thought it was the only treatment I’d need to rid the cancer from my body. Granted, I was in remission for a short time after completing that treatment until I had a deep tissue massage. A tumor popped up on my leg less than two months later.

Changing oncology practices and with a new treatment prescribed for me, I started this new blog, once again believing that the Isolated Limb Perfusion would lead me to remission. It obviously didn’t, and I’m a bit wiser and a bit more grounded in reality with each new treatment.

Before I get to the dressing changes, I want to document the week. I had a wound specialist appointment on Tuesday where they photographed and measured the wound. It’s getting a little smaller. She did more debriding and confirmed that my tendon is running through the right side of the wound (she did some debriding there too!). I told her about the continued burning, and she doubled my Gabapentin (Neurontin) dose (take two 300mg capsules every 6 hours). She added a Mesault dressing (sodium chloride).

I saw my wound specialist again on Thursday. She was happy to see some granular tissue popping through and did more debriding. I need to add that before any debriding is done, lidocaine gel is applied and allowed to sit for a good period of time before she starts cutting. Because I have some reddened skin below the wound, she prescribed Cephalexin 500mg because it’s good for soft tissue infections. This could still be pseudomonas.

Also on Thursday I had my needle biopsy of the bulge on my left pectoralis muscle. Bill was allowed to stay in the room. The doctor did three cuts and I left with a bandaid covering the site. The results will come next week. I needed to be off warfarin for 5 days before the procedure and was instructed to begin the following evening.

At physical therapy Monday and Wednesday, I had dynamic tape applied to my weak left leg to help with foot drop and McConnell tape applied to my knee. I haven’t used my brace all week! On Wednesday, I walked .3 mile in 16 minutes with no brace.

I’ve been doing a lot of dressing changes lately, and I want to document them here in case I need to refer back to them later. So, here are the steps for Dressing #1, a wet-to-dry dressing: take a 4×4 gauze and completely unfold it and then fluff it into a ball – I swirl it into my left hand; place fluffed gauze into wound; place 2 4×4 gauze squares on top (I secured these with tape to prevent rubbing); place a combine dressing over that and secure with tape; place elastic stocking over all.

Dressing #2, still wet-to-dry, but with the addition of Dakins (bleach solution) to fight pseudomonas: wet a 4×4 with a few drops of Dakins; squeeze out any excess liquid; fluff and place on wound; place Adaptic dressing; place 2 4x4s; finish as usual. Since I was having SO much trouble with the gauze sticking at the same place where I have exposed nerves, the Adaptic dressing that has vaseline on it should help.

Dressing #3: Unfold Mesault (sodium chloride dressing); cut one of the squares into a circle to fit inside my wound; place Mesault dressing into wound; fluff one 4×4 and place on top; proceed as usual. I’m adding a little extra vaseline on one edge of the Adaptic to stop the little bit of sticking that’s still happening.

My skin is very red and irritated around the wound, so it was suggested to thinly apply Calmoseptine Ointment (available over-the-counter). I can’t tell if it’s helping yet.

This week I had hyperbaric oxygen therapy treatments (HBO) on Monday, Wednesday, and Friday. There was no doctor available Tuesday or Thursday so those treatments had to be cancelled. I wasn’t nervous to begin until I got there – what if I couldn’t pop my ears! The nurse calmed me down reassuring that they would stop the treatment if that happened (and send me to an ENT doc to have tubes placed in my ears!).

I needed to completely undress, including all jewelry, lotions, etc., and put on two cotton hospital gowns and foot coverings. Then I sat on a hospital gurney for the nurse to take my vital signs and the doctor to check my ears and lungs. Then I laid back and tried to get comfy enough for the next two hours. the nurse gave me a bottle of water in case I needed it to swallow and help pop my ears. She also gave me a mask so I could breathe “room air” for 10 minutes in the middle of treatment. She slipped a band around my arm and asked me to press a big silver button that told us whether I was grounded. My foot covers were slipped off, I was covered up, and asked what I wanted to watch – choices are Direct TV, a movie from their library or yours, or your music. Although I took in several CDs of music, the nurse recommended something more distracting for my first time. I decided on “My Best Friend’s Wedding.”  The gurney is raised, slid into the HBO chamber, the chamber is closed and secured. You can hear the air blowing in and the 10-minute dive begins.

I started popping my ears every other second, too worried to allow the pressure to build. Pop…pop…pop…pop…pop…I experimented with ways to pop my ears and became quite efficient. No pain!

After the dive I breathed100% oxygen for 45 minutes, then put the mask on for 10 minutes, then back to the oxygen for the last 45 minutes. It ended by bringing me back up from the dive which lasted 10 minutes and involved more popping of ears. Vital signs were taken – blood pressure goes up during treatment (I was at 177!) and lowers back down to your baseline within an hour after treatment. Then the doctor checks your ears and lungs again. That’s it! You can get dressed and leave.

Busy week to say the least! Next week I’ll have HBO M-F, a wound care visit, physical therapy, and an INR check. I should also learn the results of the needle biopsy.

Onward!

PET Scan Results & New Treatment

I’ve had lots of appointments in planning for healing my surgical wound, which they’re now calling a radiation wound since the radiation I had for the tumor back in July is the reason for the tissue damage and the reason it won’t heal.

I visited my family doctor (ended up being a physician’s assistant, but he was great!) for my left knee pain since it’s no better and is really impacting my mobility. After a thorough exam, he recommended an x-ray and prescribed additional physical therapy just for the knee and Meloxicam to reduce inflammation. The xray results: Findings: “There is mild narrowing of the medial joint compartment and tricompartmental marginal osteophyte formation. No joint effusion. No fracture. No lytic lesion.” Impression: “Moderate degenerative change of the left knee” I’ve already begun the physical therapy sessions to strengthen my quads, something I’ve been trying to do for months. I’m even going without my brace every other day to try to strengthen my ankle and knee. Next step will be to see an orthopedic doctor.

I had a consult at the Center for Wound Care at the Rehab Hospital for hyperbaric oxygen therapy (HBO). Apparently my wound is a perfect candidate for HBO since this kind of wound has the most success with that treatment. I needed a CT scan of my lungs and a current echocardiogram to be approved.  My echocardiogram was clear with little change from 3 years ago. My lungs were clear in the PET/CT scan I had yesterday. My wound care specialist prescribed Ciprofloxacin Hcl 500mg for 10 days to combat the pseudomonas infection. She also prescribed Neurontin (Gabapentin 300mg), starting me on the lowest dose for the nerve pain I have in my right lower leg.

I’m scheduled to begin HBO on Monday morning. I need to arrive 30 minutes prior to my treatment to prepare. That means changing into a 100% cotton gown. I’ll also be checked by a doctor for clear lungs, temperature, and blood pressure. Then the hospital bed is rolled into the chamber for treatment to start. First the pressure is increased gradually for 10 minutes as though I’m scuba diving 45 feet down (they call it a dive). I’ll need to pop my ears. Then I’ll breath 100% oxygen for 45 minutes. I get a 10 minute break by wearing a mask to breath “regular” air for 10 minutes to avoid oxygen toxicity. Then I’m back to the 100% oxygen for a final 45 minutes. The process is completed by decreasing the pressure over 10 minutes and I’ll need to pop my ears again. I’ll be checked by the doctor once more, and that’s it. There are a lot of things to avoid prior to each treatment: no lotions, makeup, hair products, deodorant, jewelry, perfume, etc. New nail polish needs to be applied the Friday before a Monday treatment so all fumes are dispersed. It’s very specific! I can watch Direct TV (no HGTV though), listen to music or watch movies with CDs I bring along, etc. I think I’d like to listen to books on CD. If anyone has any good ones, let me know. I need to visit my local libraries to check out their selections.

The HBO requires quite a time commitment! They have recommended 40 treatments (insurance approved 30). I will go 5 days a week (Monday-Friday) for 8 weeks, hopefully. Initially I may feel more energized and the therapy may even reduce my pain. We’re hanging a lot of hope on this!!

The PET scan was good overall. The only thing that needs to be investigated is a small bulge on my left pectoralis muscle. It’s suspected that it’s a result from my arm exercises, but we’re going to be cautious and check it out. I have a needle biopsy scheduled for next Thursday under local anesthesia to learn whether it’s melanoma or not. If it is melanoma, it will get radiated and I’ll be done with that. If it’s not melanoma, then I will have No Evidence of Disease (NED) for the first time in years!!! It would almost be a miracle!!! All fingers and toes crossed!

Pain management and exercise are at the top of my to do list. Thank goodness for my wonderful hubby – I could not do this without his constant support and love! He is my rock and, with him, we can do this!! I also greatly appreciate the encouragement I receive from my blog readers! There are days when it’s your motivational messages that keeps me going! Many thanks and love!!