Packing Progress: Wound Care

I'm home from vacation, and tomorrow we see Dr. Nash. Hopefully, he will tell us that my wound is healed enough to stop packing.

Wound Care 101

To recap: the incision from my laparoscipic right hemicolectomy got infected, so Dr. Nash had to re-open the wound. An open wound needs to be kept open, otherwise the top layers will heal over before the rest of the wound can close - creating a little pocket just ripe for infections.

In order to allow the wound to heal in layers, from the bottom up, you keep it open by packing it with sterile gauze. "Packing" a wound is exactly what it sounds like - you just shove as much gauze into the wound as will fit. This packing helps to fill open space, maintain a warm moist environment, and absorb drainage.

How much packing do you use? That depends on how deep the wound is. Initially, my wound took about 2 feet of packing (picture taken on July 30, 2010).


As the wound healed, it became more shallow and the amount of packing we had to use got less and less. Also, we did everything to accelerate the healing process, including changing the packing twice a day and increasing my protein intake.

Today, less than a month after it was re-opened, we can hardly fit more than a couple of inches of packing into the wound. The body's ability to heal is nothing short of miraculous, and I am grateful that we are almost over this little bump on the road to recovery.

For More HELP in wound care: visit the WOCN.org website.

Founded in 1968, the Wound, Ostomy and Continence Nurses Society (WOCN) is a professional, international nursing society of more than 4,600 healthcare professionals who are experts in the care of patients with wound, ostomy and incontinence.

First In-Home Nurse Visit

VNACJ Nurses of the 1930s

The Visiting Nurse Association of Central Jersey (VNACJ) began with a meeting of volunteers on June 24, 1912 at Brookdale Farm, and has since evolved into one of the premier providers of community health care services.

Madeline, our VNACJ nurse, arrived today around 11:00 am. She was absolutely terrific, and couldn't have been nicer. In addition to redressing the wound, she answered some of our questions:

Q: If my wound was infected, why wasn't I prescribed antibiotics?
A: I did not have a fever which meant that the infection was most likely localized, and therefore the entire body did not need to be treated with antibiotics.

Q: What is the purpose of reopening the wound?
A: Usually wounds heal from the inside out, but in my case the wound healed in reverse: basically the top external portion healed over before I was internally healed - creating a "pocket" where infections can occur. The point of the packing is to keep the wound open so that the inside can heal fully.

Q: How will this wound eventually close - do they just sew it up?
A: It's unlikely that I will need stitches. Most likely, as the wound heals, the doctor will decrease the amount of packing, until eventually all of the packing will be removed. The entire wound will then be covered by a bandage, and the body should naturally heal the wound close.

Since Gary did such a great job redressing the wound, she feels that a nurse is not needed every day (and we agree). I am scheduled to receive two more in-home visits next week: Monday and Friday. She really provided some peace of mind, and Gary and I are much more confident that we can tackle this latest hurdle.

Whoa!! I was NOT expecting that!

Cancer has been a land of "firsts" for me: first MRI, first CT, first endoscopy, first bowel prep, first anoscopy, first sigmaoidoscopy, first colonoscopy, first surgery (ever), first foley catheter (you get the picture).

Today was another first - the first time we had to change my wound dressing. We started by reviewing our notes from yesterday's appointment (we have a small red moleskin notebook that we take to every appointment):

Step One: remove the old bandages and packing
- peel away the very outer bandage of sticky gauze
- remove the two squares of dry gauze
- using the tweezers, remove the approx 2 foot strip of "packing" that is stuffed into wound

In the mornings, I am supposed to take a shower between steps one and two; and let the wound get soapy water into it.

Step Two: repack the wound
- cut a 2 foot strip of packing
- soak the packing in saline, and ring out excess water
- using the long cue-tips, pack the wound - leave a little bit sticking out
- place two squares of dry gauze over the packing
- cover with a bandage of sticky gauze

Next, we laid out all of our necessary "equipment" on the bathroom counter: tweezers, scissors, "packing", gloves, extra long q-tips, bandages and saline (mise en place baby).


We decided the process would work best with me lying down, so after I was comfortably resting on a towel in bed, Gary removed all of the dressing perfectly; and when he was done, I looked down and saw the wound, for the first time.

You see, I was so nervous yesterday that I didn't look at what Dr. Nash was doing when he was re-opening my wound (I basically just squeezed the stuffing out of Gary's hand and closed my eyes). In my mind, I guess I pictured a couple stitches being cut away, revealing a dime-sized hole which was then packed with a little gauze.

So when I looked down, I was shocked to find that Dr. Nash had taken ALL of the stitches out, and there was a 1.5" gaping slash in my gut. I have never seen anything like it. Since the wound had been stretched open by the packing, it looked as if I was actually missing a chunk of my body (like a shark bite).

Immediately, I felt this overwhelming sense of panic wash over me, and I began uncontrollably sobbing, only momentarily stopping to choke out the same sentence, over and over again: "I don't think I can do this". It was the first time I was really scared since my diagnosis.

Gary calmed me down and suggested that we just put a very loose bandage over the wound so I wouldn't have to see it as I took my shower. It was a brilliant idea. Although still crying, I was able to take my shower and Gary expertly repacked the wound.

Now that the shock has worn off, I have "regrouped" as my mother would say. I still feel a little self-doubting, but I know in my heart that I CAN do this; I just need to work on some breathing and visualization techniques for the next "first" can catch me unawares.

"I know God will not give me anything I can't handle; I just wish that He didn't trust me so much." ~ Mother Teresa

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.