(Note: Since first posting this update I have decided to add updates as they occur)
Everything in me feels great, and I'm back to doing most of the 'normal' things I did before the Quintuple by-pass and carotid artery surgeries back in late April and Mid-May. As tough as that was to deal with and recover from, it seems like it never happened.
But (there's always a 'but'), my vein-donor leg continues to be a problem. Swelling, occasional pain, red, a rare blister or two, very sensitive areas and areas of no feeling at all, and one dime-size wart-looking thing that mysteriously arose from one of the blisters sometime around July. My cardiologist didn't know what it was, but thought it wasn't a problem. Most likely some infection from the blister opening up. I was told to leave it uncovered to dry out. And I did leave it uncovered but as it dried it became painful at times as the swelling around it stretched my skin to very uncomfortable levels, especially when lying in bed. The 'wart' was inspected multiple times by Nurse Practitioner, Jeff Kitch, on subsequent visits to Dr. Aduli's office. No one seemed to know what was causing it.
This is what my donor leg looked like on May 24, 2019 at 3:05 PM (ten days after my open heart surgery).
This is what it looked like on November 7, 2019
You can easily see the 'wart' near the center of the screen. That's a squamous cell carcinoma, explained below.
Meanwhile, the compression stockings that I had been wearing since the surgery didn't appear to be doing anything to help. If anything, the stockings created more of a problem. The heat and humidity in Covington kept me 'damp' to full-out 'wet' with non-stop sweating. The wet stockings obviously became a problem for my legs, especially the donor leg. I performed my rehab walking exercises inside my home until cleared for Rehab at Lakeview Regional Hospital. I began wearing the compression stockings intermittently to see if I could wear them comfortably.
I enjoyed the Rehab at Lakeview, but the leg issue continued to make each workout very difficult, mostly due to the pain associated with the swelling. The staff, including a registered nurse, were very helpful and made sure that I wasn't doing myself harm by trying to over do it. They were also concerned that I perspired a lot. It was true, but not unusual for me.
This is Louisiana in July and August, so some of the extremely high temperature/humidity/dewpoint days were compounded by my trying to walk (exercise) or work outside. Or even try to relax outside. When I removed my compression stockings my legs were not only swollen to the point of 'bursting open,' they had the look of a person's skin after hours in water. And the "dime-size wart-looking thing" appeared to be larger and for some reason, now 'threatening.'
This went on until I had a routine visit with my dermatologist. I asked her to take a look at the 'wart thing' to see if it was a dermatologist issue. She didn't want to intercede in treating it while I was still a heart bypass patient in recovery. But she said I should make sure my cardiologist looks at it. She did not diagnose or treat the bump.
Earlier during the week of 11/4, "they" (Erin Gill and Jeff Kitch, both nurse practitioners in my cardiologist's office) looked at it, took photos of it, and had no idea what it was. There appeared to be no infection associated with the redness surrounding the 'wart' because the area was not feverish. But there was still lots of fluid in both legs as evidenced by the swelling and the hardness of the calves of my legs.
Nurse Gill also gave me some samples of Livalo (Pitavastatin) which I'm to cut in half to use once a day to see if it works to lower my cholesterol (I had discontinued (with Jeff Kitch's reluctant permission) taking Pravastatin to see if there were any side effects from discontinuing it. Pravastatin caused a great deal of joint pain. The joint pain is considerably reduced by not taking Pravastatin.)
A CT Scan was ordered, followed by a sonogram and blood test. No problems there.
It was even discussed that I be hospitalized for a few days so that I could receive an intravenous antibacterial medicine. So far, nothing came of that idea.
I asked Jeff Kitch if maybe I should see my dermatologist about it. "I would!" was his response.
Two days later my dermatologist, Dr Christel Malinski, saw me (without an appointment) and quickly diagnosed the 'wart' as a squamous cell carcinoma. She took a biopsy sample. The results will take a few days. She prescribed Mupirocin Ointment 2% to apply to the biopsy wound after cleaning.
This is what the leg looked like 6 days later on 11-13-19. The biopsy wound seems to be healing nicely. But some reddish/pinkish color remains. The calf of my leg is not nearly as rigid as before. As of 11-13-19 I'm still waiting for the biopsy results, which she said could take a few days.
This image is edited in order to highlight the reddish areas.
But Dr Malinski also assessed what was causing the swelling and other issues with the legs. She said 'edema' is what is causing the swelling. The fluid has to come out. She strongly recommended that I resume wearing the compression stockings and to elevate my legs whenever possible. She explained why. It made sense. She also prescribed a lotion or cream (Clobetasol) that would help the surrounding areas of inflammation. We could afford the salve but the Clobetasol was more than we could afford, so we didn't take it. Instead, I kept using the lotion (Ammonium Lactate) that was prescribed by the nurse-practitioner, Erin Gill. The Ammonium Lactate was discontinued on 11/11 at the advice of Dr Malinski because it was not steroid based and would not help the inflammation. She gave me a sample product (Lexette) to try on the surrounding area near the biopsy wound. I am uncertain as to whether it is working.
I've since taken to wearing the compression stockings during the day and spending an accumulated 1 hour or more (usually in 20 to 30 minute periods) lying on the floor with my feet well elevated in a chair while wearing my compression-stockings. While in this position, I frequently raise one or the other leg straight up for one minute. During that time I massage (milk) the calf of the leg downward. Not being medically trained, I'm not sure if this effort works. But I have noticed a slight improvement in the calf's rigidness.
I expected to be called by Nurses Gill or Kitch during the following week (week of 11/11) to schedule a follow-up visit, hopefully with Dr Aduli, my cardiologist. I assume Dr Aduli has been briefed on everything except the biopsy results from Dr Malinski.
Nurse Gill did call late at night on Tuesday the 12th. As did Jeff Kitch's assistant, Rhen, the day before. Both said the results of the CT Scan and sonogram were excellent, as was the blood test, but Nurse Gill that she got in trouble for ordering the tests. Dr Aduli apparently did not agree that the tests were warranted since the cellulitis was no longer an issue.
I received a call from Dr. Malinski's assistant on Friday, November 15th, informing me that the biopsy was confirmed to be a squamous cell carcinoma, and it would need to be surgically removed. They will fax the necessary documents to the Skin Surgery Center in Mandeville, Louisiana, and they, in turn, will contact me to set up a surgery date.
As they say, "Every day starts with, 'We'll see what today brings.'"
