Home from the hospital --- finally. Surgery went as scheduled at 10AM. Unfortunately they could not place the new type of button tube due to inflammation and infection at the tube site. It's a vicious circle - the tube leaks because it does not fit in the folds of Estelle's skin, because it leaks, the skin gets infected, because it gets infected, it does not fit flush against the skin, because it does not fit flush against the skin, it leaks. We need to get something that fits into the fold of skin but we cannot get that until the skin is healed. The skin does not get a chance to heal because of the leakage caused because it does not fit properly and around and around the loop it goes.
The surgeon was very nice. He came out and explained to me why he could not insert the different type of tubing - he explained that he had actually tried but, because the tube will sit flush against her skin instead of having a tube which sticks out, he could not, in good conscience, leave it there due to the rawness of her skin. He said he was afraid that it would cause even more infection and no way to get to it to clear it up because there would be no room underneath the cap as there is now.
They put in a new tube of the old kind for now and spent almost an hour teaching me how to clear up the current infection so that they can insert the newer tube at a later date. It's a 5-step process involving sterile cleaning techniques, a special powder, liquid bandages, skin sealant, protective ointment and a special dressing usually intended for a trach tube but which works just fine for our purposes. I am hoping that the nursing home staff understands it and can keep up with it as it is time-consuming and complicated and needs to be done twice daily. I am going to try to get the wound care people involved thinking that they may be better equipped to deal with it than the regular floor staff. It may take a doctor's order, however, so we'll have to wait and see.
Anyhow, Estelle was unresponsive throughout the entire hospital stay and remained so even back at Woodbine. Her blood pressure was elevated and they were going to give her the tube meds as soon as possible. They said they did not have to sedate her during the procedure at all, either, as she never moved or made a sound or opened her eyes the entire time.
Her chin looks somewhat better and the bruise on her nose is healing. She was not hitting herself today - but then again, she was not awake, either. Angelica said she had a bad day yesterday with the arm movements but not at all so far today.
I am glad the tube is back in place and she can once again receive her nutrition and medications but I wish it could have been the newer version as I fear this one is destined to come out again. Hopefully, by the time it does, we will have cleared up the skin problem and the new one can finally be inserted.
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