Thursday, July 29, 2010

Warning! Not for the Squeamish

Cancer patients and doctors often speak in terms of percentages (survivor percentages, staging percentages, recurrence rates, etc). Even the treatments themselves carry risk factors.

Fact: On average, only about 10% of abdominal surgical wounds become infected (this percentage is lower at Sloan-Kettering).

In my case, we did everything possible to reduce the risk of infection. Firstly, I was instructed to take a shower the night before and morning of my surgery, using nothing but Hibiclens Antimicrobial and Antiseptic Skin Cleaner Liquid to reduce the risk of infection. Secondly, Dr. Nash was able to laparoscopically remove the 20 lymph nodes and foot of colon through one small incision, thereby decreasing the risk of infection. Finally, during surgery, antibiotics were administered.

However, it is impossible to completely eliminate the risk of infection with this kind of surgery, and despite these efforts, my wound still became infected.

Yesterday morning, I was washing my hands at the bathroom sink when I noticed the front of my shirt, by my incision area, had some light blood stains on it. When I lifted up my shirt for a closer look, clear liquid began trickling through the translucent surgical adhesive and down my abdomen. I called Gary in to look at it, and we were able to stop the drainage by having me lie down and gently blot the area with a tissue.

We called Dr. Nash's office and sent them a picture from Gary's iphone (photo on left). Based on our description and photo, Dr. Nash said I'd better come in.

To be honest - I thought the wound looked pretty good, and I was being over-cautious; however, as soon as Dr. Nash saw it he was able to determine that it was indeed infected, and the wound would have to heal from the inside out.

He explained that the redness around the wound, in addition to the fluid build up, were signs of infection. He then removed the clear, surgical adhesive patch (looks shiny in photo), reopened a portion of the wound (cut away stitches) and drained it. Afterward, he stuffed the "hole" with gauze. Finally, the entire incision was covered by gauze.

Dr. Nash informed us that this "dressing" would have to be changed twice a day. Gary was trained so that he will be able to change the dressing in the morning, and the office is going to arrange with my insurance for a home-care nurse to come and change my dressing in the afternoon.

Lessons Learned:

1. Use your iphone (or any camera phone) to digitally send pictures to your doctor if you think something is wrong.

2. Always error on the side of caution.

3. Don't rely on objectively concrete statistics when it comes to managing your own personal health care.