Drainage versus Sternum Incision Bleeding

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clumsydancer

Well-known member
Joined
Apr 1, 2013
Messages
70
Location
St. Louis, Mo
Hi all,

One quick question, doe anyone know the difference of "drainage" vs.just some bleeding from the sternal incision? I am getting some blotching on my shirts, but don't feel it is drainage perse.

Nate
 
Don't take any chances with drainage. If you have the tiniest suspicion you could have an infection, you need to have it looked at.
 
clumsydancer said:
I am getting some blotching on my shirts, but don't feel it is drainage perse.
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Some more descriptive information would be helpful. Where from and what? Blotching implies a weeping but there is nothing helpful in your description to make any meaningful comment.

However given that: I would seriously press for some swabs to be cultured.

I would be suspecting perhaps an infection with your own skin bacteria , perhaps propionibacter. This bacteria is notoriously difficult to culture, so if looking for that fella tell the lab to culture in a mixture of broths and culture for a minimum of 8days. It frequently goes undetected. It can hang around the sternal wires and can grumble away beneath the surface for years.

Please see my thread on post surgical complications. http://www.valvereplacement.org/for...nd-feelings-(some-may-find-images-disturbing)

Please also note that I am making a wild stab here with little information from you. So check out that thread and see if that fits your situation

This post in particular shows the state of the wound about 6 days post op
http://www.valvereplacement.org/for...y-find-images-disturbing)&p=533847#post533847

It was cultured then but not for long enough to catch propionibacteria .. it was only after the infection surfaced a full year later that this was identified AND only the due to a forceful argument between the surgeon and the microbiologist.

In the hospital they said that this sort of post open weeping was occasionally found.
 
Wow, that is some pretty serious stuff. Couldn't it something less serious? I'm hoping some antibiotics should cover it. I had minimally invasive AVR and am discharging clear/some blood from the bottom of the sternum wound. It does not stink nor is the wound painful.

Thanks for the information though, I will ensure when I meet the surgeon tomorrow I mention some of this. Also, I hope the issues you posted for my review have been resolved, looks painful.

Nate
 
propionibacteria IS less serious. MSR would be serious.

Of course it could be ANYTHING ELSE. Recall I said there was no information given to make a call of any kind.

But this is a fine example of what happens when you don't get onto it pronto and let the bacteria get a lead. Antibiotics will likely cover it, but in my case were not administered because everyone said the cultures were coming back negative. This is why I stress the points about culturing the swabs for an extended time. As I said:
This bacteria is notoriously difficult to culture, so if looking for that fella tell the lab to culture in a mixture of broths and culture for a minimum of 8days. It frequently goes undetected. It can hang around the sternal wires and can grumble away beneath the surface for years.
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Propioni is normally defeated by the body in most surgical contexts. However in places where there are metal wires and prosthetics it can take a hold and be difficult to control.

Infections are never to be taken lightly. Get it looked at and be informed. Don't take dissmissal fluff from the medical people. If you are not satisfied ask and research till you are. Recall that this had a year to brew!

sadly my issues are not yet fully resolved, but its looking positive.
 
I'm so sorry you're dealing with this and I trust your insight. Fortunately my surgeon is seeing me tomorrow and not pawning me off.

If we catch this early, am I looking at IV antibiotics or something orally? Or is surgery inevetible?
 
I had an infection in my incision that I caught very early on (only an area of redness that developed overnight around a certain area of my incision). I was admitted to the hospital for about 36 hours of IV antibiotics, during which time the redness noticeably decreased, and was sent home on oral antibiotics for a while (not more than a month). There was talk about the need to debride my sternum if the infection got worse or my sternum seemed unstable, but fortunately, that pit stop in the hospital and time on oral antibiotics was all I needed. They said I caught it very early and it was good that I called the minute I noticed the redness around part of my incision. Better to have it checked out than not!
 
Hi Kfay, thank you! I have caught it early and am hoping no surgery and just antibiotics, and if possible not in the hospital. But! If necessary, ill do what I have too. I just wanna be healthy :)
 
clumsydancer said:
If we catch this early, am I looking at IV antibiotics or something orally? Or is surgery inevetible?
Click to expand...

Iff (that's if and only if) its what I think it is, then oral antibiotics for a period of some weeks will likely get it. I'm currently on amoxycillin 500mg 3 times daily.

At the second surgery (first removed the wires) they removed from me a sheet of goretex (left behind by design) and things have started to improve in that area.

did you have a mechanical valve?
 
Yes, a mechanical. It's a Sorin Top Hat. Thank you for the insight Pellicle. I'm sorry your issues grew as they did. God willing, I pray I don't have to go through that, I can't imagine how hard it is for you.
 
clumsydancer said:
Yes, a mechanical.
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ok ...
I pray I don't have to go through that
Click to expand...

knowledge is power, forewarned is forearmed, so with that in mind and a stern mind towards your health and well being I'm sure you'll be fine.

Something I find myself saying a lot it "no one is invested in your health as you are", so no matter how seriously a doctor is taking the situation they get to go home ... you live with it. While I do not advocate being a hypochondriac I do advocate knowing as much as possible and seeking answers which satisfy your needs. If you feel "gee, that sounded like a load of BS to me ..." then it may have been. Ask for a version of the explanation which you get and which makes sence to you.
 
I totally agree and that's good advise. Let me ask? For your drainage that you are taking antibiotics currently, is it working? That issue seems very near my issue.
 
clumsydancer said:
I totally agree and that's good advise. Let me ask? For your drainage that you are taking antibiotics currently, is it working? That issue seems very near my issue.
Click to expand...

it makes it sound like a roofing issue :)

yes, it would seem that at the moment that the oral antibiotics are now bringing it under control. However its taken 2 debridement surgeries and some weeks (each time) on IV antibiotics to bring me to here.

I believe that if we'd got it early it would have been better.

Mean time I suggest: don't panic, get it looked at, mention propioni to the Dr, ask them to make sure that they culture for that too, and remind them that it takes much longer than the typical lab culture time to pick it up.

a few months on Amoxycillin is no real drama
 
I'm sorry for your setbacks. Honestly, you might be one of thenstrongest men I've ever heard of. I fear I am not strong enough so will be prayin for oral antibiotics. I'm one week post op, so not eager to return to the table.
 
its like the scene from Diehard 4 where the kid says he isn't as brave as bruce willis

Willis replies that he wasn't brave, its just there wasn't anyone else to do it.

From the outside it looks brave. From where I sit its just what I have to do. (don't get the idea that it has been without tears)
 
Good analogy, lol. This is tough for sure. The more I research the more it looks like its not as simple as just some antibiotics. That's annoying. Wish it were simple like other infections. Maybe they should administer antibiotics to begin with.
 
its hard to say. My advice is to first see what the results are and second formulate a respomce.

This stuff isn't minute ny minute.

I know its hard to sit tight, but thats part of being a patient.

Its all a learning experience
 
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