8 weeks post ohs- avr and aorta graph

[drewg]

where do i start... haha

went to Cleveland on 10/14 did the usual fun tests for two days (ct with they dye was entertaining, forgot how it feels like when you wet yourself)
10/16 went in for surgery. surgery went good. they did mess up my arterial line when putting it in while i was still awake. arm was bruised for 4 weeks.
don't remember much of anything in the icu. got my room room 10/17. amazed me how difficult just walking would be. i think i made it about 40 ft the first day. amazing me how loud this onx valve is, people can hear it up to around 10 ft away. ended up in the hospital for 8 days mostly because they could get my inr regulated at all. left the hospital 10/24 for the 7.5 hour drive home (not fun). went back to work part time on the 28th (2-3 hours a day). on 11/3 after i took a shower i noticed some draining (clear fluid, not infection)from my incision, looking closer at it, i noticed a small hole. called Cleveland 24 hour doc. he said head to the er, just in case of infection. they did a culture of the "hole". on Monday 11/4 my surgeons p.a. said head back to Cleveland. so i made the 7.5 hour trip again (not fun after they crack you open). ran all the fun tests again, waited for my surgeon to get out from surgery. then he proceed to take a scalpel and open up 4 inches of my incision. he kept asking me if i felt any pain, but all i could feel was blood running down my body. he stated that the skin was so thin there was no nerve endings. so he opened me up 4 inches along the incision and it was down to the sternum (could see the sternum wires. pretty large hole to have) they didn't want to stitch back up since then there would be a larger risk for infection (or they just didn't want to take the time) so they packed it full of gauze pads and set me up with a home nurse company for give me a "wound vacuum". so 7.5 hour drive home again. had the wound vacuum on till 11/26 (works amazing, but painful when they have to change dressings). was back to work full time 11/11. other then all this fun stuff, been feeling good, im now just on the baby aspirin in the morning, metro 25mg three times a day and my warfarin at night.

all in all, glad to be alive, and it wasn't nearly as bad as i thought it would be. as for the depression thing, i hate to admit it but around day 5 i was walking around the hospital and just broke down emotionally for no reason at all. i find myself being a wimp for sad things now. as before i was a "manly man" haha. but i think anyone will admit the same after ohs. if they don't they are most likely lying.

there is probably many things im missing in this. but if anyone has any questions or anything let me know.

by they way i had a onx 27/29 put in. and my 6cm aortic aneurysm was replaced with a graph.

cheers
Drew

 

[Paleowoman]

Oh dear - that sounds not good what's happened with your incision. You say the surgeon said your skin was thin - is that because you're thin ? Is that why there was a problem with healing ? I'm glad you're feeling "good" though ! Hope the incision wound heals well - isn't it going to be 'wide' since they haven't stitched it up ? Or will they do some 'plastic' surgery later ?

 

[pellicle]

Hi

glad to hear you're home

... on 11/3 after i took a shower i noticed some draining (clear fluid, not infection)from my incision, looking closer at it, i noticed a small hole. called Cleveland 24 hour doc. he said head to the er, just in case of infection. they did a culture of the "hole".

what have they said?
my first guess is propionibacteria. It was what infected me too. In my case they decided to remove the wires. It can be a stubborn bacteria to remove when it gets into wires. Its actually well reported and documented in the prosthetic limb and spinal support area, but not well documented in Cardiac.

If nothing comes back suggest to them to culture for greater than 9 days as if its propi then it takes longer to culture. It can also require a multi-faceted approach to culturing for it does not grow well outside the host.

If you were on antibiotics prior to the swab it may not even turn up ... that's the nature of antibiotics.

on Monday 11/4 my surgeons p.a. said head back to Cleveland. so i made the 7.5 hour trip again (not fun after they crack you open). ran all the fun tests again, waited for my surgeon to get out from surgery. then he proceed to take a scalpel and open up 4 inches of my incision. he kept asking me if i felt any pain,

bizzare ... bet that felt surreal!

(could see the sternum wires. pretty large hole to have) they didn't want to stitch back up since then there would be a larger risk for infection (or they just didn't want to take the time)

know that feeling ... one shot from my 2nd debridement image here <- only click that if you want to see it ... I removed it from being visible in the post because the sternum is visible (link is to an image on my flickr so its safe in that way).

other then all this fun stuff, been feeling good,

excellent ... glad to hear a positive attitude!



BTW, I had my wires removed and that seems that that may have dragged it behind the sternum, as I then had another debridement there too.

Sorry to hear of another going through this. At least propioni is not as difficult to deal with as some are.

I'm still on antibiotics after Nov 2012 debridement after Nov 2011 OHS. My progress is on my blog post here.


Best wishes, keep us posted.

PS, some reading should your medical team require some prodding

http://jcm.asm.org/content/49/7/2490.full

Mine did

 

[Paleowoman]

know that feeling ... one shot from my 2nd debridement image here <- only click that if you want to see it ... I removed it from being visible in the post because the sternum is visible (link is to an image on my flickr so its safe in that way).

Is that hole closed now pellicle !?!?

 

[pellicle]

Hi

Is that hole closed now pellicle !?!?

Yes, thanks for asking, much like the last picture in the blog post, but without the blood blister

 

[drewg]

as it pertains to the "hole". the explanation i got was...... they said the incision healed fine, but right under the healed skin a cavity formed the length of 4inches. when this happens there is nowhere for the fluid to go besides out, causing a small hole in the incision. the thin skin im talking about was the healed incision, it was so thin covering the unknown cavity there was no nerve endings. when the doc cut the skin there was a cavity down to the sternum. there was no infection (thank god).

they told me this is a common thing to happen just not on a large area like mine, and most people it just heals and they don't even notice there was a "cavity" under there skin.

hard to explain. haha... but it was interesting. and the wound vacuum was amazing for the healing of this.

the wound vacuum- they put a "sponge" in the shape of your wound in. then make it air tight and hook up a machine they constantly vacuums the wound. (this actually felt good, like pressure on any wound) they would come change the dressing sponge three times a week. the wound vacuum claim is to reduce the healing time by 75% for large open wounds. and i do say that's very true.

 

[pellicle]

!?!?

Anne, the hole healed but they made a second hole (for the second debridement) because while it closed there was a continuing discharge.

The VAC dressings are excellent as drewg identifies. The VAC dressing looks like this:

http://cjeastwd.blogspot.fi/2012/11/vac-pack.html

and the foam packing looks like this:
http://cjeastwd.blogspot.fi/2012/11/vac-pack.html

the idea is that 1) vacuum encourages the growth of tissue in to fill the area
2) the changing of the foam every 2nd day 'debrides' the wound and removes any bacteria which may have colonized the wound surface (note colonized as opposed to infected).

VAC wound dressings have really made great strides in deep wound healing. I was surprised that Gail in CA did not have one for her wound treatment....

The reason for the ongoing antibiotics is because noone knows if the bacteria is actually gone, or attached to something else. Looking at my X-Ray (posted in the thread) you can see many little chunks of metal lying around from previous surgeries. IFF the bacteria gets onto one of them it can not be eradicated without removal of that item.

I have discussed at length these issues with the Dr treating my infection (and I have a microbiology background) and his view is that step 1 is 1 year on antibiotics.
When I cease that I will begin taking PET scans at intervals to identify if there is anything growing where it shouldn't be if it is (and I hope it is not) then the next step is to attempt another antibiotic regime which will include using Rifampicin as a killer of bacteria (antibiotics do not kill bacteria, they simply halt bacterial growth by inhibiting cell wall formation).

Rifampicin is incompatible with Wafrarin however and so we need to determine another anticoagulant for that to occur. Xeralto is the current one in my sights, but it is not approved as an anticoagulant for valve patients.

So essentially that post on my progress will continue to be updated more until after May 2014

 

[pellicle]

Drewg

they told me this is a common thing to happen just not on a large area like mine, and most people it just heals and they don't even notice there was a "cavity" under there skin.

the same was said to me on discharge from the hospital. I had a squirt of fluid come from my wound the day I was released. They held me back in ...

I expect that it is more common that nothing comes from fluid discharges than something does. I'll still keep my fingers crossed for you.

The thread on my progress starts here:
http://www.valvereplacement.org/for...nd-feelings-(some-may-find-images-disturbing)

Most probably you'll be alright

 

[Paleowoman]

Thanks for posting those links pell ! I've left a coment on your blog too It's great you made a photographic record !

 

[pellicle]

It's great you made a photographic record !

as you probably noticed, I'm a camera geek

 

[drewg]

pellicle,

it was nice reading your story, and see another person kind of go through what i did (im sure there are many out there). even though mine was a couple weeks after ohs not a year... crazy. now im worried about round two... haha... i liked the picture of the wound during the first vac dressing change, the red square mark of where the adhesive tape was, brought back memories of 4 weeks ago... my skin was so happy to have the adhesive tape off, and able to breathe when the vac treatment was complete.

also having the vac i have a new respect for women, having to carry purses... haha.... carrying around the vac with me became a part of me. my "man purse" i called it. and having to go to work with it was a pain, had to run the tube down my arm sleeve of my dress shirt daily...

never thought id be having to deal with this at 28 years old... but hey i am alive

hope you all have a great holiday

cheers

Drew

 

[pellicle]

Hi Drew

it was nice reading your story, and see another person kind of go through what i did (im sure there are many out there).

yeah ... when I was a kid I used to feel better if someone was with me down at the principals office too ;-)

now im worried about round two... haha...

I think you'll be fine

i liked the picture of the wound during the first vac dressing change, the red square mark of where the adhesive tape was, brought back memories of 4 weeks ago... my skin was so happy to have the adhesive tape off

and remember it was high summer in Australia for me then, so 38C days! Man was I glad to get that last one over and done with!

and not carry that bloody thing around (I called mine Wilson).

had to run the tube down my arm sleeve of my dress shirt daily...

intersting. I ran mine out the back of my shirt where the belt of my pants was ... once I put it out through my fly but I was given "the look" by management
;-)

hope you all have a great holiday

you've got the right spirit for this! Good on ya!

Merry Christmas!

 

[Lynlw]

where do i start... haha

went to Cleveland on 10/14 did the usual fun tests for two days (ct with they dye was entertaining, forgot how it feels like when you wet yourself)
10/16 went in for surgery. surgery went good. they did mess up my arterial line when putting it in while i was still awake. arm was bruised for 4 weeks.
don't remember much of anything in the icu. got my room room 10/17. amazed me how difficult just walking would be. i think i made it about 40 ft the first day. amazing me how loud this onx valve is, people can hear it up to around 10 ft away. ended up in the hospital for 8 days mostly because they could get my inr regulated at all. left the hospital 10/24 for the 7.5 hour drive home (not fun). went back to work part time on the 28th (2-3 hours a day). on 11/3 after i took a shower i noticed some draining (clear fluid, not infection)from my incision, looking closer at it, i noticed a small hole. called Cleveland 24 hour doc. he said head to the er, just in case of infection. they did a culture of the "hole". on Monday 11/4 my surgeons p.a. said head back to Cleveland. so i made the 7.5 hour trip again (not fun after they crack you open). ran all the fun tests again, waited for my surgeon to get out from surgery. then he proceed to take a scalpel and open up 4 inches of my incision. he kept asking me if i felt any pain, but all i could feel was blood running down my body. he stated that the skin was so thin there was no nerve endings. so he opened me up 4 inches along the incision and it was down to the sternum (could see the sternum wires. pretty large hole to have) they didn't want to stitch back up since then there would be a larger risk for infection (or they just didn't want to take the time) so they packed it full of gauze pads and set me up with a home nurse company for give me a "wound vacuum". so 7.5 hour drive home again. had the wound vacuum on till 11/26 (works amazing, but painful when they have to change dressings). was back to work full time 11/11. other then all this fun stuff, been feeling good, im now just on the baby aspirin in the morning, metro 25mg three times a day and my warfarin at night.

all in all, glad to be alive, and it wasn't nearly as bad as i thought it would be. as for the depression thing, i hate to admit it but around day 5 i was walking around the hospital and just broke down emotionally for no reason at all. i find myself being a wimp for sad things now. as before i was a "manly man" haha. but i think anyone will admit the same after ohs. if they don't they are most likely lying.

there is probably many things im missing in this. but if anyone has any questions or anything let me know.

by they way i had a onx 27/29 put in. and my 6cm aortic aneurysm was replaced with a graph.

cheers
Drew

Hi Drew, Sorry to hear you ran into a bigger bump post op ...(AND you had to drive 7 1/2 hours back and forth) but glad to hear it sounds like CCF was really proactive and things are better now. It kind of sounds like what happened to Justin after his 1st OHS when he was 10 days old. They called it a sterile abscess, since there was no bacteria in it, in his case and a couple others i know of, it was caused by his body not dissolving the "dissolving sutures", some times it only happens with one or 2 of the stitches and it can look like a pimple forming, but that surgery, I took him in because i didnt like how the wound looked (it was 5 weeks post op but first week home after being born) and they lanced the whole thing like they did with you, that surgery was between his ribs around his back, not down the sternum, and the three inch incision covered half of his back since he was about 5 pounds at the time.. We did "wet to dry dressings" for a couple weeks and everything was fine. the reason I mention what happened to Justin w/ the stitches was if it happens once in a person it can happen again when/if you need other dissolving stitches for surgery. Luckily after we knew what to look for and that Justin tended to have a problem with it, as soon as there was something that looked like it might be forming, we took him in and they pulled that stitch so it never got as bad.

Beside that time, Justin has had both Bacterial endocarditis , when he was 11 and a post op infection in his sternum and under it, when he was 19, which really stunk for him, but hopefully it helps others going thru similar things to know how he did and that things are good now (knock on wood) He's pretty close to your age now, he'll be 26 in April.
oh no biggie, but you have a graft not graph

good luck with everything
Lyn