Friday, November 22, 2013

A Great Post Op Appointment 11/19/13

This last Tuesday, November 19th, I had my post op appointment in Portland with my new burn doctor, Dr. Kim.  Portland is a 4.5 hour drive away from where I live and this was our third trip in three weeks so I was a little tired to make another trip.  The drive there was not so much fun.  Like I said, this was our third trip in three weeks, I was tired of traveling the 4.5 hours there, sleeping in an uncomfortable bed (for me), and I'd just had surgery.  There were a lot of negative things at play on the trip over.  I tried to sleep as much as possible but again, uncomfortable.

My appointment was the following morning.  We usually try to make appointments for a morning so that way one of my parents, whoever is going to drive me, can work half a day in the morning and then we drive over that afternoon, stay the night and go to my appointment the next morning, come home.  My appointment this time was at 10:00 AM.  My dad was with me.  We woke up early so the morning seemed to drag on so slow as we waited to go to breakfast before the appointment.  Finally we checked out and headed to the restaurant to have breakfast before the appointment.  We had some time but we ordered our food and seriously about 10 minutes later our food arrived.  So, we were an hour early to the doctor.  But, it worked out for the best because we got in about 40 minutes early.  Hot dog.

My appointment started out with fun teasing between Steve and I.  Then he (sort of) got down to business taking out the stitches that held the bolster on top of my graft.  I say sort of because he was still saying things that made me laugh and visa versa even though we should have been a bit more serious as he was dealing with a delicate matter in getting that bolster off.  But that's just the type of relationship we have.

Even through all of our giggling, Steve got the bolster off and man it felt good to have that thing off.  He looked at my neck and said, "Looks great!  Wanna have a look?"  Yeah, of course.   I sat up and my dad first came over to look at it and then I walked over to the mirror behind the door and had a look.  Looked fantastic.  I moved my neck in different directions to see where it still pulled and there were some places but there always are.  The point, though, is that it wasn't pulling too bad in all the regular places so I felt good about that.  I was a little worried earlier in the week cause it still felt like it was pulling in the contractions so I feared he didn't get at the problem.  But the fear quickly diminished when the bolster came off and the contractions relaxed.  The graft looked good, looked healthy was a 100% take!!  I've never had a 100% take in all the surgeries I've had so this was very exciting!

(My latest neck graft from surgery #40 - full thickness, 100% take)

Steve left to get Dr. Kim who came in shortly after.  He had a look at the graft and began explaining what he did by drawing on a paper towel.  This was pretty cool cause I've never had it explained to me before how exactly they do the release and then the graft.  So, that was very interesting.  He also had a look at my donor site and said the stitches needed to stay in for another week cause the donor site was under a stressing pull because of it's location.  He's going to let my mother take them out since she has experience in taking out stitches when we were with G.  G often worried about us making the drive so my mother learned a lot of different things to take care of donor sites and grafts and taking out stitches was one of them.  So, Dr. Kim said it would be fine for us to take them out ourselves and not worry about driving back over.

I then asked about my lip.  I told him it has been a major problem for these past 5.5 years, ever since I was burned.  I have trouble eating, it can be difficult to talk sometimes and I often have a drooling problem.  He was very sympathetic to all of these things and basically said that he wanted to give my neck time to heal and then we would tackle my lip!  I was SO EXCITED at the prospect of FINALLY getting my lip worked on!!!  G always said we had to get my neck under control before we could even look at my lip but he also never knew what to do to attempt fixing my lip so it was like pulling teeth with him when it came to the reconstruction of my lip.  So to hear Kim was ready and willing to tackle the lip situation without hesitation was so exciting and promising.  I was hoping to get it worked on before the year was up but I understand he wants my neck to heal first.  I go back in January for an appointment to really have a look over on my lip and make plans for surgery!!!  FINALLY!!!  I can't describe to you the kind of relief and excitement I feel at the thought of finally getting my lip worked on!!  Oh, this is so GOOD!!

Sunday, November 17, 2013

My 40th Surgery

Last week on Tuesday I had my 40th surgery.  They performed a release and full thickness grafting procedure on my neck.  For those of you who don't know skin grafting is the transportation of skin from one area to another.  There are two types of skin grafting: spit thickness and full thickness.  A split thickness graft, which covers most of all of my body, includes the epidermis and part of the dermis of the skin and is much like peeling an apple or potato.  A split thickness can also be put through a skin mesher where it can expand up to nine times its size.  A split thickness graft is more commonly used as it can cover larger areas and its chances of being rejected by the body is low.  You can also take from the same site multiple times after it has healed.  A full thickness graft is where they cut out the full thickness of the skin, both the dermis and epidermis, at the donor site.  The donor site is then suture closed instead of just left to heal.  Both of these are called "harvesting the skin."

I always get nervous before a surgery because I don't like being put to sleep but, I was more nervous than usual for this surgery because it was with my new burn doctor.  Nothing against him, he's perfectly capable.  It's not like he's fresh out of medical school.  It's just my first surgery with a new burn doctor and he doesn't know my complicated body that is webbed with contractions and scar tissue and how it will respond.  I usually have an early morning surgery but this time my surgery wasn't until 2:15 in the afternoon so I had nearly all day to get more and more anxious and I didn't have much to do to in the hotel to keep my mind off of it.  So, I just kept thinking about everything that had gone wrong in the past and everything that could go wrong again.

FINALLY, 12:00 rolled around and we were off to the hospital to check in by 12:15.  Everything went as normal except the time of surgery changed to 3:00 and we were not told.  So, that was a little annoying but, the time slowly ticked away with med check questions, getting an IV in, and soon Dr. Kim was in to see me.  He had me look up and side to side to see where the contractions were on my neck and the way it pulled on my face.  He also had me pull up my gown on my legs to see where the best place to take the full thickness donor site from would be.  He marked me all up with a marker on my neck and on my upper right leg in my groin area where he had decided to take the donor skin.  Then he was gone to go do an operation before mine.  Dr. Scott, my anesthesiologist, whom I have had before, walked in around a quarter to three.  I remembered him and he remembered me.  It had been awhile since I had pain medicine and I was in pain so he gave me some IV pain medicine and said they were just about ready to take me.  Three o'clock tolled and the head nurse for the surgery and the anesthesiologist came back in, put up the rails on my bed, Dr. Scott put some "feel good" medicine in my IV to calm me down and help me relax and I said good bye to my mom as they wheeled me out of my room and headed to the OR.

My surgery was about 2 hours, just as Dr. Kim said.  But he did it a little differently.  Usually they clean out the contractions and scar tissue at the site and remove the damaged skin before replacing it with the donor skin.  What Dr. Kim did was simply make a cut in the skin across the contractions, let it split open, and then ADDED skin to where it split open.  At first I thought that was really the best way to do it.  To ADD skin rather than always trying to cut it out and REPLACE the whole thing only for it to contract back down again.  But I'm worried about him not cleaning out the contractions.  I can't see how it looks because there's a bolster stitched on top of the graft.  I can feel it and it feels better, but I think I can still feel the contractions at the top of the bolster with my finger, just barely cause of the bolster being in the way and they still feel like they're popping out.  So, I'm not totally sure of how it was done.  I'll know more when I get to see it at my post op appointment when the bolster is removed.

(Bolster stitched on top of graft on the neck)

My donor site looks good, though.  It's terribly painful, though, because it's right in the crease of my groin where my thigh meets my hip and it's about 7.5 inches long.  So, I can't really stand up so straight or it pulls really tight at the donor site.  And dressing changes hurt like the dickens because it's such a sensitive area.  Getting the stitches out on that one is not going to be fun.  I am not looking forward to that post op appointment.

 (Full thickness donor site, 7.5 inches long and sutured closed)

And speaking of my post op appointment, it is this Tuesday, Nov 19th so I will know more about my graft on my neck, how it looks, feels and if it took, get stitches out, and also I hope to discuss what we will be working on next in my reconstruction.  I'm going to try talking to him about my lower lip.  It's time to get something done about that and I think Dr. Kim will get it done.  At least I hope so.

Thursday, November 7, 2013

My New Burn Doctor

It's been awhile since I've written, I know.  I've been in a lot of pain and under a lot of stress lately.  So I've been spending a lot of my time dealing with those things and going to doctor appointment after doctor appointment.  My shoulder is unfortunately hurting again the way it did before I had surgery.  My orthopedic doctor said that this can be normal as scar tissue has blood supply and nerves wrapped up in it and as a result, pain can occur.  As my right shoulder is chock full of scar tissue, like the rest of my body, my extensive pain makes more sense.  But that's not exactly what I wanted to write about today.

What I really want to write to you about is the doctor appointment in Portland I had with my new burn doctor.  Yes, I said "new."  A bit ago, when I called to make an appointment with G, I found out that he was no longer at Legacy Emanuel, which is where I have my surgeries.  And in fact, they didn't know where he had gone to.  They didn't know why he left and they didn't know if he was practicing anywhere.  This news really upset me.  I had been working with him for five and a half years and went through 28 surgeries with him.  I trusted him.  He knew my body, the way it worked and how it responded to things.  We had a close relationship and that's very important in an extensive and involved doctor/patient relationship such as ours.  So to lose that and have to start again with another doctor is very upsetting and hard on your hope.

In G's place is a new doctor, Dr. Kim, with the same specialties as G had so plastic surgery and burn reconstruction.  I always seem to have a hard time liking my doctors, warming up to them and developing a relationship with them.  And this particular doctor/patient relationship is so very important to me cause it's the reconstruction of my body from the accident.  So, I had been worried since I made the appointment with Dr. Kim that I wasn't going to like him or he wasn't going to be kind and warm like G was or he wasn't gonna be willing to help me like G always was and so many other things.  But I got one nice surprise while I was waiting in the waiting room.  I was discussing G's sudden leave with one of the front desk girls when she told me G's old PA (Physician's Assistant), Steve, was back.  Oh, relief.  I was so happy to hear that.  I really adored Steve.  And I loved the G, Steve, and SB team we had going through the years before Steve left, and then G left.  We were fun together.  But, it was so great to hear that Steve was back cause at least he knew most of my case.  Knew how my body scarred and healed and reacted during surgery.  And also, he was a familiar face from before things went all hazy on me with G's leaving.

Unfortunately, Dr. Kim didn't make the great first impression by being an hour late.  I understood though.  I know these doctors can get caught up in surgeries and emergencies.  Finally I was called back.  And soon enough, Steve and Dr. Kim entered.  As soon as Steve opened the door he put me at ease by falling back into our old rhythm with, "Oh, here's trouble!"  With which I replied, "And here's bigger trouble!"  Dr. Kim introduced himself and I got a good feeling right away.  He started out by saying that Steve caught him up a little bit with my case.  He asked me some questions to get to know me and my burn better.  He wanted to see the free flap area on my leg that G did.  He kind of touched me all over and "explored" my body, more or less, to see where I was grafted and where there was skin yet to harvest.  There was some, "Take off your pants so I can see....." and "Can you show me your buttocks where they took that full thickness graft," and taking off my shirt so he could see my torso and back.  None of this phased me though as I was looked at like an item in a museum for 4 months while I was in the hospital by doctors, nurses, interns and physical therapists.  And then he wanted to know what I was in for that day.  I was there to see him about my neck.  My neck has been operated on 9 or 10 times alone and it always seems to get worse again and contract.  My chin and jawline are disappearing again because the scar tissue and contractures are so thick.  I turn my head and it pulls the whole side of my face.  It's pulling my lip down and out again to where it's hard to eat and talk.  And it's extremely uncomfortable.

After he had examined me and we talked about my neck and he took pictures, he asked me when I wanted surgery done.  I'd never been asked this before.  I was always just told, "we'll get it scheduled and call you."  So I it didn't take me more than a second to reply, "As soon as possible."  And he said, "OK, we'll make it happen."  And the appointment was over.  I was happy with the new doctor all in all, I think.  He was warm and kind and seemed proactive.  I think he needs to look over my case more with Steve though.  But I'm hoping he'll go over my history more before the surgery to get to know my body a little better and I hope he STAYS proactive most of all.  I hope he understands that I have a lot of things to work on and that will continue needing work on throughout my entire life.  G understood that.  I hope Dr. Kim will, too.

But I was pleased coming out of my appointment.  I felt it was a bit rushed but only because he was late.  I think he did a great job with seeing me with the time he had so that's OK.  I was even more impressed when on our drive home, I received a phone call from his MA who was all ready to schedule my surgery only 5 hours after I'd seen him.  I was VERY happy with that.  Usually I'd wait for a month and often have to call back to remind them we were doing surgery before it finally got scheduled and then it was another month away.  But I was called to schedule surgery immediately and they got me IN for surgery right away.  Surgery is next week already.  He is going to do a full thickness graft on my neck.  This isn't a new procedure for my neck.  It's been done two or three times before.  But that's what he wants to try this time around.  I don't trust him yet.  Like I said before, it takes me awhile to develop that trusting doctor/patient relationship so he's gonna have to prove himself to me, more or less.  I need to see that he can handle my body during surgery, handle my pain during recovery and stay proactive with my reconstruction.  But, right now, I'm pleased with him so far.