Monday 3/31 am
Victoria took shower, debried, cleaned and dressed wound.
9:45 am
Arrived ID for appointment with Dr of podiatry (DrPod). He looked, did a little debrieding, dressed the wound with a silver infused pad. Gave us a prescription for more pads. Talked about wet/dry dressings. Left about 11am
1:15 pm
Returned to ID for appoint with Dr(supervising the IV - DrIV) and Wound Nurse (WN). She undressed the wound and began aggressively cutting away tissue. She cut away a piece of bone in the foot for a culture. DrIV joined came in and looked. He dug around with his finger and said the joint was impacted and only surgical intervention would work. He recommended a Surgical Dr (DrSur) at different Hospital with WN’s concurrence. He left to attempt to get an appointment. I complained about the dressing on Friday and that no one seemed to be willing to get into the wound. It had been a week since we first came and only TODAY did someone actually do something with the wound - even though DrPod and WN acted completely opposite. WN complained of the dressing, the lack of debrieding and the first nurse that opened the dressing for WN complained that the compression dressing (done by DrPod) was done badly and wrong. I said that if no one was going to take ownership, we may as well try somewhere else. If people were going to sit back and say, too bad, foot has got to go and be unwilling to get in and try to save the heel, please, get out. I don’t want to deal with them. Give me someone that is going to try their damnest - and I will do everything within my power to help - or get out.
DrIV returned and WN and he suggested a full contact cast. This would limit everyone’s ability to treat the wound daily, but the damage being caused by Victoria’s walking - even as limited as it has become - would prevent any healing. We were sent to casting. WN and we agreed to 36 hours. Wednesday morning the cast would come off and we would see if the time off the heel helps. An appointment with the DrSur was scheduled for 1:15pm Wednesday.
After casting the foot, Victoria got her IV antibiotics. We left at 5pm.
Monday, March 31, 2008
3/29 and 3/30
Saturday 3/29 am
Cleaned and dressed wound; arrived at clinic approx 9am IV antibiotics administered, left at 9:45am
Sunday 3/30 am
Arrived at clinic approx 9am, IV antibiotics administered - noticed significant bruising around PIC site. Left at 9:30am. Arrived home, debried, cleaned and dressed wound.
Cleaned and dressed wound; arrived at clinic approx 9am IV antibiotics administered, left at 9:45am
Sunday 3/30 am
Arrived at clinic approx 9am, IV antibiotics administered - noticed significant bruising around PIC site. Left at 9:30am. Arrived home, debried, cleaned and dressed wound.
3/28
Friday 3/28 approx 2pm
Arrived ID for IV antibiotics. Numerous attempts to get IV in failed. Temp 102. PA was called for. PA viewed wound, nurse cleaned around wound, used squirt bottle to flush out wound. Told to go to Hospital for PIC install and IV, wound dressed AND A SOCK PUT ON. Sock pushed dressing off the wound to the rear of heel.
Approx 4pm
Arrived at Hospital. Taken to Imaging, PIC installed. Sent to Surgery & Procedures, IV administered. Left approx 7:15pm
Approx 7:45pm
Arrived home, removed sock; dressing had completely come off wound area. Cleaned, removed tissue stuck to sock, cleaned and dressed wound.
Arrived ID for IV antibiotics. Numerous attempts to get IV in failed. Temp 102. PA was called for. PA viewed wound, nurse cleaned around wound, used squirt bottle to flush out wound. Told to go to Hospital for PIC install and IV, wound dressed AND A SOCK PUT ON. Sock pushed dressing off the wound to the rear of heel.
Approx 4pm
Arrived at Hospital. Taken to Imaging, PIC installed. Sent to Surgery & Procedures, IV administered. Left approx 7:15pm
Approx 7:45pm
Arrived home, removed sock; dressing had completely come off wound area. Cleaned, removed tissue stuck to sock, cleaned and dressed wound.
3/27
Thursday 3/27 approx 6:30am
Victoria got up to go to bathroom, foot was dressed but a significant amount of fluid (mostly blood) was seeping; this was the first time any fluids or bleeding came through a dressing. Changed dressing.
Approx 10am
Arrived for appt with Wound Care. Nurse looked at wound, measured and said she was calling Infectious Disease(ID). Dressed wound. ID requested we come as soon as possible. We obtained appt at 1pm
Approx 1pm
Arrived at ID. Seen by PA, several nurses. PA took culture, ordered blood and IV antibiotics. Scheduled IV antibiotics daily for 6 weeks. Seen by Wound Nurse, specialist in wound care; she measured, then wound was dressed and a specialized shoe was provided to remove pressure from wound area. Taken off oral antibiotics. Left at approx 5 pm.
Victoria’s foot was slipping in shoe badly, distending her ankle. Stopped using once home. Debried, cleaned and dressed wound - significant fluid in old dressing.
Victoria got up to go to bathroom, foot was dressed but a significant amount of fluid (mostly blood) was seeping; this was the first time any fluids or bleeding came through a dressing. Changed dressing.
Approx 10am
Arrived for appt with Wound Care. Nurse looked at wound, measured and said she was calling Infectious Disease(ID). Dressed wound. ID requested we come as soon as possible. We obtained appt at 1pm
Approx 1pm
Arrived at ID. Seen by PA, several nurses. PA took culture, ordered blood and IV antibiotics. Scheduled IV antibiotics daily for 6 weeks. Seen by Wound Nurse, specialist in wound care; she measured, then wound was dressed and a specialized shoe was provided to remove pressure from wound area. Taken off oral antibiotics. Left at approx 5 pm.
Victoria’s foot was slipping in shoe badly, distending her ankle. Stopped using once home. Debried, cleaned and dressed wound - significant fluid in old dressing.
3/26
Wednesday 3/26 approx 10am
Arrived at DR office for appt with primary Dr. She measured wound, ordered X-Ray and had us scheduled for Podiatry on Monday 3/31 and to be seen by Wound Care on Thursday am; nurse dressed wound; left approx 11am;
In the evening, I cleaned and dressed wound
Arrived at DR office for appt with primary Dr. She measured wound, ordered X-Ray and had us scheduled for Podiatry on Monday 3/31 and to be seen by Wound Care on Thursday am; nurse dressed wound; left approx 11am;
In the evening, I cleaned and dressed wound
It began small
and grew.
For those with no experience concerning diabetic foot uclers, they look terrible. Well, more than look, they ARE terrible. It takes no time for a small infected scratch to turn into a nightmare. 12 to 36 hours can turn a 1/2 scratch into a wound 3 inches in diameter, an inch deep. Ten CUBIC inches of tissue can die and turn into a foul smelling hole with death on it's lips overnight. This is our third bout. And it looks like we are not going to dodge the bullet this time.
We have no insurance. Our income is just middle class, but it will fail to cover the costs we are going to incur. If we can survive this, it is going to cost tens of thousands. If we don't, $100,000 is possible, even likely.
So, let's start with the history:
Wound start approximately Dec 15, 2007 with small tear of dry skin from bottom of heel. Found pine needle in wound approx 2 days later, wound then about 2" in diameter, in skin only. Kept clean and dressed with antibiotic ointment and dressings. Approx 1 month infection flared and wound grew to approx 4" in diameter - no bleeding, puss, bad smell, no softness in wound. Continued with cleaning, debrieding of callous around edge of wound. Minimal bleeding when removing hard tissue around edge of wound during this time. Traveled on 3/19 and I got sick (stomach flu), dressing changed only 3 times in 5 days. Dressing changed am on 3/24.
Tuesday 3/25 approx 6pm
Change of dressing found softness and small hole in wound. Using cotton swab, attempted to clean hole and determine size - large...size of grape at least. Dressed wound and left for emergency medical services (EMs)
Arrived at EMs approx 7pm, timely seen by Dr. He measured wound, added a dressing and prescribed oral antibiotics with instructions to see primary physician next day. Left at 8:10pm. Ran to Walmart to pick up antibiotic. Pharmacy closes at 8:30p. Got there in time and our Pharmacist had seen the faxed order and gotten it ready.
For those with no experience concerning diabetic foot uclers, they look terrible. Well, more than look, they ARE terrible. It takes no time for a small infected scratch to turn into a nightmare. 12 to 36 hours can turn a 1/2 scratch into a wound 3 inches in diameter, an inch deep. Ten CUBIC inches of tissue can die and turn into a foul smelling hole with death on it's lips overnight. This is our third bout. And it looks like we are not going to dodge the bullet this time.
We have no insurance. Our income is just middle class, but it will fail to cover the costs we are going to incur. If we can survive this, it is going to cost tens of thousands. If we don't, $100,000 is possible, even likely.
So, let's start with the history:
Wound start approximately Dec 15, 2007 with small tear of dry skin from bottom of heel. Found pine needle in wound approx 2 days later, wound then about 2" in diameter, in skin only. Kept clean and dressed with antibiotic ointment and dressings. Approx 1 month infection flared and wound grew to approx 4" in diameter - no bleeding, puss, bad smell, no softness in wound. Continued with cleaning, debrieding of callous around edge of wound. Minimal bleeding when removing hard tissue around edge of wound during this time. Traveled on 3/19 and I got sick (stomach flu), dressing changed only 3 times in 5 days. Dressing changed am on 3/24.
Tuesday 3/25 approx 6pm
Change of dressing found softness and small hole in wound. Using cotton swab, attempted to clean hole and determine size - large...size of grape at least. Dressed wound and left for emergency medical services (EMs)
Arrived at EMs approx 7pm, timely seen by Dr. He measured wound, added a dressing and prescribed oral antibiotics with instructions to see primary physician next day. Left at 8:10pm. Ran to Walmart to pick up antibiotic. Pharmacy closes at 8:30p. Got there in time and our Pharmacist had seen the faxed order and gotten it ready.
Friday, March 28, 2008
Pictures
Pictures are from first to latest. Scroll down to watch the progression.
This is a picture of Victoria's foot on 3/15, about 10 days before we headed to the ER. The black in the right center is a large scab. The pink around the edge is good tissue trying to grow and heal. The area around 10 o'clock is where the tissue got soft (the internal infection started).
This is 4/4. The 'thing' inside around 8 o'clock is the heel bone. Yes, it is very exposed. Most of the yellowish tissue is dead and was removed today by the debrieding machine and WN's work. If you want to figure the damage, the wound is about 4" in diameter and about 1.5" deep, roughly 19 cubic inches of tissue is gone. This is 6 times larger than her previous ulcer and of course, the bone is fully exposed here.
This is the heel on 4/14. The notch at about 11 o'clock is where the width is measured. The black around the outside is 'scab'. Dead surface tissue. The very red ring is area of new tissue growth. Most of the yellowish tissue inside the wound was removed by debrieding.
This is 4/21. The notch at 11 o'clock has all but been filled in. The darkness in the wound at 7 o'clock is leftover ointment that is used to promote tissue growth. You can see there is considerably less yellowish tissue inside the wound. WN removed a lot of the dark dead tissue from around the wound after this picture was taken. If you look at the wound on 4/4 and see the dark rim near 1 o'clock, you can see the change in where the opening is in comparison. There is almost 1/4" of good, healthy tissue between the current opening and the edge of that dark rim.
Latest look, 4/28. This is AFTER the cleaning with the ultrasonic debrieder. There is a noticeable 'lip' on the wound at this point (the skin on the surface is closing faster than the tissue is filling in. Although the overall size has changed only slightly, the depth is considerably improved; it is 1.9cm deep (2.4 was the previous reading). If it looks cleaner to you, it is. Both the internal and external surfaces are getting to be JUST healthy tissue. The 'bloodiness' is a good sign that the tissue is growing and blood flow (a crucial issue) is growing with it. Also, notice the shape has changed from mostly round, to oval.
This is on May 9th right after the cast was removed. The tissue looks good, the orange at the bottom is drainage. That hole is the only deep spot still remaining, but it give access to the bone.
Also on 5/9, this is after cleaning and debrieding. the purpose of this is to show that the tissue has good profusion - the tissue has blood flow. It makes it healthy.
This is 5/14. The tissue continues to grow, but the hole at the bottom is persisting. This place will be the most difficult to close. After debrieding this, the tissue looked similar to the photo above, but the wound looks smaller - it is marginally.
This is a picture of Victoria's foot on 3/15, about 10 days before we headed to the ER. The black in the right center is a large scab. The pink around the edge is good tissue trying to grow and heal. The area around 10 o'clock is where the tissue got soft (the internal infection started).
This is 4/4. The 'thing' inside around 8 o'clock is the heel bone. Yes, it is very exposed. Most of the yellowish tissue is dead and was removed today by the debrieding machine and WN's work. If you want to figure the damage, the wound is about 4" in diameter and about 1.5" deep, roughly 19 cubic inches of tissue is gone. This is 6 times larger than her previous ulcer and of course, the bone is fully exposed here.
This is the heel on 4/14. The notch at about 11 o'clock is where the width is measured. The black around the outside is 'scab'. Dead surface tissue. The very red ring is area of new tissue growth. Most of the yellowish tissue inside the wound was removed by debrieding.
This is 4/21. The notch at 11 o'clock has all but been filled in. The darkness in the wound at 7 o'clock is leftover ointment that is used to promote tissue growth. You can see there is considerably less yellowish tissue inside the wound. WN removed a lot of the dark dead tissue from around the wound after this picture was taken. If you look at the wound on 4/4 and see the dark rim near 1 o'clock, you can see the change in where the opening is in comparison. There is almost 1/4" of good, healthy tissue between the current opening and the edge of that dark rim.
Latest look, 4/28. This is AFTER the cleaning with the ultrasonic debrieder. There is a noticeable 'lip' on the wound at this point (the skin on the surface is closing faster than the tissue is filling in. Although the overall size has changed only slightly, the depth is considerably improved; it is 1.9cm deep (2.4 was the previous reading). If it looks cleaner to you, it is. Both the internal and external surfaces are getting to be JUST healthy tissue. The 'bloodiness' is a good sign that the tissue is growing and blood flow (a crucial issue) is growing with it. Also, notice the shape has changed from mostly round, to oval.
This is on May 9th right after the cast was removed. The tissue looks good, the orange at the bottom is drainage. That hole is the only deep spot still remaining, but it give access to the bone.
Also on 5/9, this is after cleaning and debrieding. the purpose of this is to show that the tissue has good profusion - the tissue has blood flow. It makes it healthy.
This is 5/14. The tissue continues to grow, but the hole at the bottom is persisting. This place will be the most difficult to close. After debrieding this, the tissue looked similar to the photo above, but the wound looks smaller - it is marginally.
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