In the hospital and need advice
 

I am hoping someone can help me.

I saw my Plastic Surgeon last Thursday and she noticed I was beginning an infection in the area of my incision on the non-affected side. She put me on Bactrim until I saw her a week later.

Unfortunately over the weekend things got worse the infection spread across my chest and fevers were running wild. Called the doctor Monday but she was in surgery all day so she asked me to come in on Tuesday morning. Went to the appointment and ended up in the hospital with a PICC line in and am now on Vacomycin. They ran blood work and found there is not enough antibiotic in my system so they have upped the meds. Already was informed I am going home with the PICC line and antibiotics.

My question is the doctor may take the expander out tomorrow morning "wash" it and return it to my chest or just remove it altogether since my infection is no better no worse since I was admitted. Has anyone had this procedure done???? Obviously I know if she takes it out and leaves it out I can not have it put back in until I am all done treatment which will not be until 2013. I am not sure I want to jump to surgery since they realized I have not been getting the proper dose of meds. Is it wise to ask the doctor to hold off on the surgery to give the meds a little longer to work at the new dose or just do it and be done. Obviously I do not want to jeopardize my life with an infection and she said since the implant is a foreign body it may not allow my body to heal but I hate the thought of more unplanned surgery. I was originally supposed to have my port replaced tomorrow and start my next round of chemo next Monday but that is now all put on hold which gives the cancer a chance to come back while I am fighting this infection..

Someone please throw me some advice. I am just not sure what to do..

Thank you very much
Tracy

Re: In the hospital and need advice
 

I'm so sorry to hear this is happening to you. It is not uncommon though, I've heard of it happening to a number of woman.

I do think it's appropriate for you to ask for anything you want from a doctor. Then they give you their medical opinion and you go from there to make your decision. I know women who have had to have their expander taken out for a few months to let their body heal and the infection clear up - that is quite distressing, I am sure. I'm not sure why you think you would have to wait until 2013 - it's a good question to ask your doctor. To my knowledge, as soon as chemo is done you can have surgery, I had surgery on herceptin - several times. But, you should err on the side of what your body needs to heal.

Good luck to you - let us know what happens.

Re: In the hospital and need advice
 

I developed an infection the day after they pulled the drains out on my L (involved side) My PS recommended that we take the expander out which would mean that I could not put it back in since I was going to have radiation. I wanted to try to save it and tried 3 bouts of antibiotics and was in his office 2-3xwk getting fluid drained out to no avail. My skin started to breakdown, this was during my chemo so I'm sure my body was not able to fight the infection. When he pulled the expander out he said I had a seroma under the expander which was feeding all the fluid build-up. It was very hard emotionally for me, I really did not want to have the other reconstructive surgery with a muscle transplant. But the fact that my skin was starting to breakdown I could no longer put my health at risk.
I have come to terms with the fact that I now have to have the muscle transplant surgery (going to do the latissimus flap) I have been without anything on the L since last October. It has been a long wait but I think in the long run I am healthy and am looking forward to surgery in Dec.
I figure if this is the worst I have to worry about ie delaying surgery, I'll take that to any alternatives we as cancer patients could be facing. Hope this helps and hope your infection clears up soon.
Suzanne

Re: In the hospital and need advice
 

First of all I am surprised your doctor did not send you to emergency if you let her know you had high fever and spreading infection! These days infections are nothing to LET GO even for another day.

If you have been on a hard chemo your body is much less able to fight infection let alone a form of "superbug."

Now you are in a more serious position, and it might be useful to know exactly which kind of infection you have. Some are VERY difficult to be fully rid of. Especially if they want to leave in the PICC line, it seems they may expect you to come back.

These are the kinds of questions I would want answered before moving on to the expander question. We have had a few women post here over the years that infection developed and it seems most of them had to leave it out for a while.

Sorry to hear you have this setback.

Re: In the hospital and need advice
 

I'm so sorry to hear Tracy- what an ordeal to go through! I'm sending lots of healing vibes your way!

I don't know if this will help or not as my situation is a little different. I had a mastectomy in August, while still on chemo. (I will more than likely always be on some kind of chemo and initially surgery was not recommended.) But my tumor was coming through my skin so it had to come out. While I have not had infection, I have had a really hard time in keeping my incision closed and having the tissue underneath heal completely. I just went to my surgeon again today and was referred to a wound clinic for ongoing care. I've had two surgeries to clean out the wound, re-stitch it, and yet it reopens. My immune system is just too compromised from chemo apparently.

My doctor also said this is exactly why he hesitated when I asked about reconstruction... he too talked about the implant as a "foreign body" and said it may have made my situation all that more difficult to deal with. But he always left the final decision with me.

Its a really personal decision and I just wish you well no matter what you decide!

Re: In the hospital and need advice
 

Coolbreeze

Thanks for the help. I only thought I could not put the expander back in since I have 3 months of FEC coming up and then 6 weeks of radiation and then I will be on Herceptin for a year.

I saw the doctor tonight and she has me on the schedule for tomorrow for 1pm but said she will be back in the morning to make a final decision. Yes my biggest problem is this is a setback to treatment but I am also thinking she is cutting into the same incision that is already infected to me that doesn't make much sense but she knows what she is doing.

Again thanks for the response.

Tracy

Re: In the hospital and need advice
 

Suzanne

Wow I am sorry you had such a hard time with recovery. Sounds like you think the way I do- give it your all or nothing. I am however glad you are feeling better about the path you are on now. I know I will basically do whatever the doctor feels appropriate tomorrow. Thanks for the message and my thoughts are with you as you continue your journey.

Tracy

Re: In the hospital and need advice
 

Hi Tracy,

I am so sorry you have to go through all of this. The only thing I can ad is my ps said they will only use an incision twice because they have to take away some of the skin all around the old incision to get a straight angle. Rarely do they do a third because they risk making an uneven form. I hope this helps. Gods blessings to you. I pray all goes well for you. Please know that you are in my prayers.

Your Friend,

Nancy

Re: In the hospital and need advice
 

i am ready for reconstruction surgery. I lost my left breast Jan 29, 2010. I healed really well after the radiaton, that took 6 months to heal. I have to find a PS to go see. I think I will call my surgeon and ask him avout a referral to a PS. My surgeon is a breast care surgeon onlyl I know he takes them off..dont know if he does the reconstruction or now. I am ready for a boob. I want to wear tank tops and not worry about my fake one peepng out. Am I bad for that. but wait when i get the new one i want the old one modified to be like the new one... uplifted rounded out.. did anyone else ever do that?

Re: In the hospital and need advice
 

I know very little about reconstruction issues. But my Father had many infections. When possible, a tissue sample might be able to determine what bacteria is involved and what antibiotic it is killed by. Vanco is near the top of the antibiotic chain..but there are others in the same league like Daptomycin and Tigecylcline. Make certain blood tests are negative, i.e. NOT septic. If things are not resolving quickly, be sure an "infectious disease" specialist is onboard. Most hopitals have a few. If they haven't checked the bloodstream for infection, request it.

Re: In the hospital and need advice
 

Thanks Nancy, Candlegranny and Rich66,

I actually escaped the hospital last Friday in time for my kids 12th birthday weekend. They did confirm the infection is Cellulitis. Came home with the PICC Line and Vanco 1250 MG for 14 days. Saw the PS today and she is still hoping to save the expander but I saw the Onc today and she says she doesn't think it can be saved. We will see what happens. Still in alot of pain but dealing with it. Onc is pushing to start chemo again next Friday and she is pushing to replace the PICC Line with another port but I basically informed her today no surgery to replace the port until after the first of the year. Since we are starting chemo ASAP I want a break from the rest because mentally I am so ready to walk away and say no more treatment what so ever. Anyway enough of my griping.. Thanks for the advice, well wishes and good thoughts.. Always thinking about my new found friends here and what part of their journey they are on.

Re: In the hospital and need advice
 

To Suzanne,

Had you considered a DIEP flap? They don't cut your muscles for that, but it is a very long surgery, because they do microsurgery to transplant fat and skin from your abdomen (but they leave the muscle alone, unlike a TRAM flap where they take the abdominal muscle). Also, I was told that with the latissimus dorsi flap, they often need to use an implant along with the flap because they don't get enough volume with just the muscle from the back.
I live in NJ, and flew all the way to San Antonio to have my DIEP flap done. Unfortunately I had complications, where the flap started to fail and they had to rush me in for emergency surgery, and then I had complications with my lungs. But I am happy with the results, and was very happy with the doctor. I did not want to have any muscles cut, and we never even tried an implant because I had a lot of damage from radiation that i had 4 years prior.
I just want to make sure you are aware of all your options.
Good luck with the surgery, and keep us posted!
Pat

Re: In the hospital and need advice
 

I'm so sorry to read your post and the struggles you are facing. I have no advice but just wanted to let you know that you are in my prayers :)

Jessica

Re: In the hospital and need advice
 

PS told me I don't have enough fat around my belly to do the DIEP (I disagree :), plus he doesn't do that surgery nor does anyone in town I would have to travel to Houston, I'm from El Paso. Don't want to travel and the recovery time is quicker. I work in the health care field and need a quicker recovery so I can get back to work. I do struggle with the fact that I am going to have a weaker L arm as I am very athletic but I am also very determined and will work that L side out to get my strength back as close as I can.

Re: In the hospital and need advice
 

Snolan,
Don't want to be pushy BUT the Center for Resorative Breast Surgery has done thousands (literally) of Dieps and SGaps on women who were told "no way" by other Surgeons.
At the very least contact them and send photos and u might be pleasantly surprised,
Best wishes for swift healing and a successful recon!
Marcia
(www.breastcenter.com) also known as the NOLA Docs!
PM me if u would like to chat. I was a bilateral delayed stacked DIEP who no one else could reconstruct (2 breasts)

Re: In the hospital and need advice
 

I had something similiar and I am sorry to say that I lost my implants but I went with NOLA and had flap reconstruction surgery. They will not do the surgery while you are having chemo (I believe) BUT they will do it while you are just on herceptin. I had 2 surgeries while I was just on herceptin. I was told locally that I didn't have enough fat and NOLA proved them wrong. Sorry that you are going thru all of this.