Monday, April 21, 2008

Back to the Sutures

I went to the hospital today for a quick blood test ("bloods" for short). Since they let me out early and everything, they want to keep an eye on the bloods to keep an eye on my neutrophils count, white blood count, hemoglobins and platelets. When I left on Friday my neutrophils were rising slowly; my white blood count was rising nicely; my hemoglobins were okay; and my platelets were low enough that they needed to be topped off, but nothing critical.

Since it's Passover much of the hospital is a ghost town. I stopped by 7NW (my ward; that's "seven northwest") to say hi to the gang, and checked out my labs after they'd hit the computer system. The only thing I really cared about was my neutrophils count—I'd like to stop wearing masks when I go to the store, thank you—and they're only at 0.4. To frame that properly, I'd usually be sent home only once I hit 0.5, would be considered mildly neutropenic at 1.0, and non-neutropenic at 1.2.

Anyway, after I had my bloods done I had my chest catheter dressing changed, because the dressing was starting to peel already. This has happened the last few times it's been changed; I suspect it's because I'm sweating more with the warmer weather, increased physical activity and recent recurrence of the night sweats.

While that was being done, the nurse working on me removed some of the sutures from my lines. When the catheter is installed, it's pretty quick surgery, but it's still surgery. That means sutures to close the hole around the tube as best as possible until the skin heals. I didn't think about sutures when I first got the catheter in—who would?—and when the gauze was finally removed I noticed what looked like wires sticking out of my chest. That is, in fact, what they were; these sutures appear to be fine stainless steel. Parts of them were eventually cut away during regular maintenance (aside from changing the dressing, the lines also get flushed to clear away blood clots and other buildup, and the claves at the end get changed), but the rest are still inside—think of snipping the threads that hold a button in place on your shirt from only on side.

The sutures that are inside gradually work themselves out of the body. I haven't mentioned it until now because it's a painless, dull process. Every so often I'd look down and notice that the sutures had come out a little more, wrapped around the catheter tubing. When they got long and annoying, they were trimmed.

It took four months, but the first bunch of sutures finally came out in their entirety today. Before my new dressing was placed, the nurse carefully removed them from the tubing, threw them away and cleaned the tubing. I looked down and noticed other sutures were starting to work their way out.

Now, normally when I get my dressing changed it feels uncomfortable for a few hours. When the old dressing is removed the skin is cleaned with Stanhexidine (chlorhexidine gluconate, 2%) antibacterial solution, which is cold, and air-dried. The new dressing is placed, usually a different way from the old one, and the lines are arranged differently on my chest. (Each nurse has a different style, it also lets the skin breathe and, I guess, keeps the lines from settling into one shape.) So while my nerve endings get used to a new arrangement for another week, it sometimes itches or tingles until everything settles in.

Today, I noticed it was actually feeling kind of uncomfortable—and, more alarmingly, localized. When it started to get really irritating I realized the pain was right at the tube's point of entry, which is the prime spot for any kind of infection. I was starting to get antsy about that possibility when I noticed that the new sutures had actually come out further. Vicky noticed that the spot just to the side of the entry point was red (how she spotted that through the dressing from a distance, I'll never know), and when I touched it I could feel the threads through the skin.

What appears to be happening is that these sutures are working themselves out at a faster rate—I never would have noticed such a difference in a matter of hours before—and as a result it's irritating my skin. So now there's a sharp little pain in my chest every so often as they do their little mambo. I'll have to make sure they don't poke through the dressing, too. Fun.

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