post surgical complications and feelings (some may find images disturbing)

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pellicle

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Hi

perhaps this is not the correct location to place such a topic, and perhaps there is little anyone can say in responce to this topic. So if a moderator wishes to move it then by all means.

I had my most recent OHS in Nov 2011, I have an Aortic valve replaced with an ATS valve and had a section of my aorta replaced/repaired with a tube of some fabric such as dacron.

All things progressed towards reasonable healing with the exception that I complained of the wires bugging me through out the healing process. Bear in mind I saw no reason to mention this significantly till well past 8 weeks.

Things progressed with some minor aches and pains until November 2012 *(yes a year later) when I found that the upper part of my sternum was beginning to swell.



This progressed to a point where it became obvious to the surgeon that something was amiss. That lead to a surgical 'debridement' of the wound and the removal of the sternal wires on the 23rd of November 2012.



The recovery of the surgical wound has progressed in good time.

Throughout the recovery while the wound looked as perfect as one could hope for in a wound recovery there remained a light greenish discharge coming from the top of the wound, which was actually just short of the manubrium, and the source of the swelling in the first place.



It was clear that a 'discharge' of green liquid which continued to flow (more or less at an unchanged rate) from the top of the wound indicated that an infection lay beneath, even if the wound itself was clear of infection. The wound management people said that the wound itself showed no signs of infection but that the discharge should be viewed as a problem.

The wound has now closed and (surprise surprise) the manubrium is now swelling again.

Right now I am feeling a mixture of emotions which seem to range through anger, despair, frustration, depression and numbness. That I am also still struggling with the totally unexpected and shocking passing of my dearly beloved wife just in August 2012 does not help me to maintain an even keel on all of this.

However I feel that I would like to take this opportunity to remind those who seem to take lightly entering into multiple OHS that you are foolish in the extreme to do so lightly. OHS is a life threatening event, and the recovery is not straight forward.

Do not take the successful outcomes of one or even two surgeries to beguile you into thinking that its just an arduous process. It is far far more than that. If you have had a straight forward recovery (as indeed my first two were), then give thanks to whatever deity you believe in and do not tempt such deity to intercede for you in the third surgery.

Your doctors/surgeons will (or should) rightly tell you that each sucessive operation multiplies the risks, not the least because of the simple aspect of statistics. The healing of wounds through scar tissue are unlike the initial healing of wounds. Blood flow is different and susceptibility to infection or incomplete healing is more likely.

So to those who consider a tissue valve and re-operation at a later date due to a pathological fear of warfarin anti-coagulation therapy I advise you to consider:

* do you really know what you are talking about with your issues of warfarin?
* if you were in my situation would you wish you'd not had your third?
* is the risk of anticoagulation therapy greater than the risks of post surgical complications?

Naturally there are other reasons why one would be "contra inticated" for a mechanical ...

In my case I had little choice about a third operation. I had my first as a valvotomy when I was a youth, my second as a human tissue implanted valve (homograph) in my late 20's and this third operation (at 48) we considered only a mechanical valve. Both the surgeon and I were not wishing to undertake a fourth.

I have no idea what will come of this next, but I will keep you posted if anyone finds any value in that.

As the kids say "FML"
 

DebbyA

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Pellicle,
The medical side of your story is one of the more severe I can remember reading here, and it's so sad that your burden was compounded by the loss of your wife. Your participation in this site in view of those troubles is admirable.
 

ottagal

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Debby has eloquently articulated a reply that I would like to echo as well.
You have been through alot and probably more than many people. My wish for you is that in time you will not only 'heal' from your complications, but also your grief. Losing a loved one is very difficult in and of itself. You have have had alot to endure over a short period of time.
When it is time for my second surgery, I will take into consideration other's experiences.
 

ski girl

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Pellicle I was thinking of you the other day and wondering how the healing was going . . . still got fingers and toes crossed that you improve soon. Have they considered removing part of the sternum? There is someone on this forum who no longer has a sternum (can't remember his name) but maybe he will chime in with his story.
 

virginian777

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i'm having my 2nd surgery feb 14th 2013 because the first valve is leaking hope the best for you and a speedy recovery did the doctors say what cause the problem?
 

pellicle

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Hi all

thanks for your kind words of support.

Skigirl, I do have a friend (well the father of a friend) who has come and spoken to me in hospital last time. He too has had a sternum removal. I hope that I am not looking down that path. If I am then icehole swimming in Finland has just seemed attractive for the first time.

I believe that the bug in question is not as virulent as some of the Staphylococcus family, and I believe that it is Propionibacterium acne (a common skin bacteria)

Propionibacterium acnes is the relatively slow-growing, typically aerotolerant anaerobic, Gram-positive bacterium (rod) linked to the skin condition acne; it can also cause chronic blepharitis and endophthalmitis, the latter particularly following intraocular surgery. The genome of the bacterium has been sequenced and a study has shown several genes can generate enzymes for degrading skin and proteins that may be immunogenic (activating the immune system)
... further ...

P. acnes is an opportunistic pathogen, causing a range of postoperative and device-related infections e.g.,surgery,[14] post-neurosurgical infection,[15] joint prostheses, shunts and prosthetic heart valves.

The medical side of your story is one of the more severe I can remember reading here
that's possible, but I believe that it is not one of the more severe in general. I expect that there are many many valve recipients who have never heard of or have the interest in participating in a forum such as this. I guess that by default most on the register here represent a skewed sample of outcomes. By that I mean skewed towards the more positive outcomes.

Again thanks all for the good vibes. It does help steer me away from the negative thoughts
 

Gail in Ca

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Wow, you have been thru the ringer. Holy krap, those pictures are so real. I can't believe what has happened to your sternum incision.
Did you take antibiotics? Was it festering all this time? Geez! I totally agree about the repeat surgeries. I would never have chosen a 3rd, either.
My gp today was admonishing me about being more careful and think about what I'm doing, so I lessen my risk of another bout of endocarditis.
I surely hope the doctor is on top of this for you, now. This is nothing to let go, oh my God!
 

Jkm7

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I'm very sorry for all you have endured but wonder how it got so out of control, so badly? Wasn't your incision checked regularly? Didn't you know it wasn't healing well? Not having experienced it, I have no image of how that could happen.

I certainly wish you the best and hope you have a good resolution very soon.
 

pellicle

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Wasn't your incision checked regularly? Didn't you know it wasn't healing well? Not having experienced it, I have no image of how that could happen.
Yes it was, it healed and sealed neatly. This lay under the surface for a year before manifesting.

Probably was the cause of "the wires bugging me for months" but my immune system probably kept it in check. The death of my wife in August and the accompanying grief probably lowered my immune system and combined with the extra chest movement (I have done a lot of crying in the past months) exacerbated it.

Who knows
 

katm

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My heart breaks thinking of your pain both physically and emotionally. My thoughts and prayers for healing will be with you. Take care Pellice.

Katm
 

pellicle

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Well it seems that they will do another debridement operation on Friday. They did a type of CT scan where they injected contrast down the wound to see if they could follow the trail to the source of the infection.

The path led down to the sternum. So it could be that there is a small part of dead bone or a staple or suture down there allowing the infection to remain.

Will post more post operation
 

ramjet

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Dear Pellicle,

Thanks so much for posting your story and the images. I am certain you are correct about the skewed information provided on the forum, as I am almost certain that if I were in your position I may have not bothered posting the detail, and clearly if complications result in critical outcomes, then we will never hear about it first hand on this forum. But you just have to talk to the surgeons and the front line nursing staff with years of experience, and from what they tell me they absolutely don't see your type of complciation every day, honestly. Yes, clealy infections happen, and yes, they are very serious, but its not common place, thats for sure,a nd I'm sorry that you have experienced this on top of everything else. You can bet that the medical staff are using the image of the wound where you can see the measuring tape when they are teaching junior surgeons about complications.

Unfortunately, antibiotics work systemically, and they are typically very poor at "entering" puss, infection, or areas of teh body that don't have good blood flow. So its necessary to undertake "source control" where the wound is debrided, or cut away along with dead tissue, and the puss is scooped out...and then hopefully blood flow can carry antibiotics and healthy blood to the area...but this is clearly quite deep unfortunately.

Take care, stay focussed on getting better, and try and stay fit and healthy otherwise to give your body the best chance.
 

Pat J

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Pellice,

This is really scarey. I'm having my first surgery on Friday. I hope I am brave enough to deal with what you have had to deal with if something like this happens to me. Have you tried any homeopathic remedies for the infection as it sounds like you have a strong immune system to deal with this for such a long time.
 

AOS518

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Hi I'm so sorry you are going through this. I am curious though did the swelling at the manubrium start slowly and progress or was it you woke up one morning and it was swollen to what the picture shows? Also did you have any other signs and symptoms? I have a small lump near the end of my incision that almost feels like a pimple but it hasn't come to a head or gone away so I'm not sure if its normal healing or something else. I have a follow up with cardiologist on Tuesday so I will ask when I see her. Good luck with everything.
 

pellicle

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Good morning Roger (Ramjet right;-)

Yes, clealy infections happen, and yes, they are very serious, but its not common place, thats for sure,
That is very true, and is what you find when reading the stats, if you know how to read them. Part of my purpose here is to bring attention to the "it can't happen to me" viewpoint and to refocus this group on the facts that while you stand an excellent chance of a good recovery that one should not consider it a certainty and one shouldn't consider these procedures flippantly or lightly.

I certainly did not expected this post surgical complication when I had my procedure,but then it would not have altered my decision as death within a year was a certainty without my 2011 OHS.

I am happy with my decision as my wife did not have to suffer grief at my loss and was each day happy with my progress towards the healthy guy of before the discovery of the aneurysm.

:)
 

pellicle

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Hi

. I am curious though did the swelling at the manubrium start slowly and progress or was it you woke up one morning and it was swollen to what the picture shows? Also did you have any other signs and symptoms?.
The swelling progressed so slowly that at first I failed to observe anything special. It progressed quite regularly and wasn't for around a week that I was sure it was abnormal. At first the outline of the manubrium was simply slight raised.

This image was taken some 8 days after the image at the top of the page.



I consulted my GP (General Practitioner) and he was uncertain as to what to do. After nearly 3 weeks of constant enlargement I finally got through to the surgeon (you would not beliveve the bureaucracy here) who was away.

In another 4 days it had grown more substantial



Finally I got through to him and when he saw the images wanted me in immediately. The whole time involved was about a month (if you discount the time from about Feb when I was complaining about the wires). I have my suspicions that the problem was manifest at the beginning, but what would I know right?


As a background I had been complaining of chest wire irritation for some months and was given the usual answer of "it doesn't usually cause a problem".

I am certain that it usually doesn't. Equally Doctors deal with a great diversity of pain reporting from the stoic sufferer to the hypochondriac whinger. Thus getting meaningful quantitative data from patients is fraught.

There are many migating factors influencing the likelihood of good outcomes:
  • is this your first surgery
  • are you younger or older
  • general health condition
  • diabetic
  • ...
The less surgeries you have the better, but there are always reasons why.
 

ramjet

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Hello again pellicle,

I was somewhat the opposte somehow... I kind of did expect post surgical complications, and was indeed so fortunate that my sternotomy wound....so far.....has healed very very nicely...and I'm forever amazed at that really. I kind of expected almost the worst...but for me the big, big surprise was the neurological effects....memory and directions mainly...it was a mash for quite a few months...referred to as "pump head" by some nursing staff....the effects of cardiovscular bypass on neurological function....but once I got my limited brain power around the fact that it might be normal for some people and that it might get better I just started to laugh at myself...but boy of boy, there were quite a lot of tears as I suffered in silence, because I just didn't know what was happening in my head.....but its better now, and I am so thankful that so far I haven't got any sort of serious infection....but the lesson here for us all is to be vigilent, learn from your expereince, and the moment we suspect an infection get it seen and treated as soon as possible....in the hope that it doesn't progress. Pellicle, if you are so inclined, sould you kindly keepus posted on your treatment and how you go, your experience is indeed helpful to us all.

After teh surgery I had quite a firm lump at the top of my sternum at the top end of my scar, and I was worried about it, but was assured it wasnormal and it wouyld go away, which it did. At no stage was it infected though, and I was told later that that was where the internal stitches from the skin and muscle (not the sternal wires) had been tied, and the stitches would slowley get absorbed, and hence the lump would go away, which it did thankfully. Edit, I see your new image now, thanks. My lump was not that big, and my lump was right at the top of the manubrium, at the supra sternal notch

Anyway, take care Pellicle....

You remember the cartoon. "Roger Ramjet he's our man the"....well, I'm no hero unfortunately, but I admire your willingness to share this experience with us.
 

pellicle

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. At no stage was it infected though, and I was told later that that was where the internal stitches from the skin and muscle (not the sternal wires) had been tied, and the stitches would slowley get absorbed, and hence the lump would go away, which it did thankfully.
I had a different situation, as my wound showed a clear discharge just the day I was to be released.



I bent down to pick up my bag and light yellow watery liquid jetted from the top of the wound. This was treated with antibiotics and the weeping stopped. I was kept in hospital or a further 4 days and monitored until the weeping stopped. In hindsight the infection clearly hid somewhere.


Edit, I see your new image now, thanks. My lump was not that big, and my lump was right at the top of the manubrium, at the supra sternal notch
Nor was mine post surgery. It is critical to comprehension of this issue to recall the significant times:
  • no apparent problems with wound for 10 months post op
  • discomfort in the wires appearing as the wound healed and the discomfort from that bone and skin healing subsided
  • sternal swelling noted 10 months post surgery
  • debridement performed 12 months post surgery
  • this second debridemnt being done 3 months after initial debridement
You remember the cartoon. "Roger Ramjet he's our man the"....well, I'm no hero unfortunately, but I admire your willingness to share this experience with us.
I do :)

Anyway, I hope this information assists others in any way.
 

pellicle

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So here I sit now out of ICU after my second debridemnt operation.

The result are encouraging and frustrating all at once.

They followed the small sinus that was oozing pus into the top of the last debridement wound. This lead the surgeon to the top of the manubrium and to notice that in behind it and the sternum a sheet of goretex which was harbouring the infection. He was able to remove this whole.

The sheet is normally laid there to prevent adhesion growing from the eternal wound scar tissue down onto the heart and causing it to adhere to the wound.

In this instance as the infection had made its way there it was acting as a reservoir for it, a safe haven from the antibiotics.

This of course raises some questions, such as how did the infection get there, via the sternal wires or over the top of the supersternal notch?

How far has it gone down?
Is it safely separated from the heart by enough tissue to prevent the Dacron sock that is my ascending aorta from now being infected?

Meantime I sit here on alternating timentin and vancomyacin

Will keep you posted
 
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