Dear Dr. Roach: I had a port put in for chemotherapy. I have a red scar on my chest and a smaller one near my collarbone. None of the nurses have seen one placed in the neck before. Was mine put in wrong, or is this a new style? What can I do to lessen the red scars when I have it taken out? I hate the scar near my neck. Would a laser be helpful?
R.R.
A chemotherapy port is a medical device to make it easier to provide access to a central vein in order to give medication, especially chemotherapy. They can improve a person’s quality of life, since the nurses and doctors don’t need to put in multiple (uncomfortable) peripheral IV lines, which often fail due to the toxic nature of some chemotherapy on the veins. They are most commonly put into one of the jugular veins in the neck or the subclavian vein under the collarbone. There’s no need to think that the port was put in incorrectly.
I hope your treatment will be successful, and they will no longer need the port. Once that happens, the port can be removed surgically. Scars, for any reason, are often red in the first weeks or months after the incision. Over time, the redness usually fades, and the scar becomes more skin-colored, sometimes paler than the person’s normal skin.
Some treatments are used to improve the cosmetic appearance of the scar. Keeping an ointment, such as petrolatum (Vaseline), over the scar helps it heal. I’ve had success with silicone gel sheets. Plastic surgeons sometimes use lasers, dermabrasion or even surgical scar revision when the patient is particularly dissatisfied. I have very seldom had a patient go through that.
Dear Dr. Roach: I am a 67-year-old female and recently did an overnight sleep test that showed “light” obstructive sleep apnea, with an AHI number of 8.5. However, oxygen saturation fell below 90 per cent several times during sleep. My daytime oxygen is between 98 and 100, which I measure throughout the day.
Should I be concerned about my nocturnal readings? Do you recommend supplemental oxygen based on this one test, or should more data be gathered? I have no symptoms of headaches, shortness of breath or a racing heart. I wake up refreshed and energetic with no sleepiness.
F.B.
The apnea-hypopnea index (AHI) is a measure of severity of sleep apnea. It reflects the number of times a person stops (or reduces) breathing during the night, with your AHI meaning, on average, you stopped or slowed breathing 8.5 times per hour. This is usually considered mild. (Moderate is an AHI between 15 and 30, while anything over 30 is severe. I have seen levels over 100.)
However, the decision to start therapy is also based on symptoms, and it doesn’t seem you have any, although I wonder why you had the sleep study to begin with. Sleep studies are expensive and often scarce tests that are done only when the suspicion is high for sleep apnea. Based on what you are telling me, there is not a clear indication for treatment.
The usual first treatment for obstructive sleep apnea is a continuous positive airway pressure device, which is effective at improving symptoms. Nighttime oxygen has not been shown to improve symptoms and can sometimes worsen the periods of stopping or slowed breathing, so it is not a recommended therapy.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
