4/10

8am

Arrived early at ID for cast change and wound work. CT came out and got us and we went in to the room. When he took off the 'slipper', it was obvious there had been a lot of seepage from the cast. The slipper is a rubber sole with 3 straps: one around the back of the heel, one over the top of the toe joints and one that goes over the ankle. As bad as the inside bottom of the slipper looked, there was NO indication there had been any leakage from the cast???

He took it off and there didn't appear to be any stains in the batting under the foot. Odd. Shortly thereafter, WN came in. First was an appreciative smile. She liked the way it looked. She too thought the stain in the slipper was odd given the lack of such on the cast.

She informed us that the new fangled ultrasonic debrieder was broken and unavailable. So, into the wound she dived. Using scalpel and surgical scissors she cleaned up the area around the wound removing all the dead and calloused skin. When she was done, she used some gauze and 'cleaned out the wound opening. Then, with a 'scrapper' she began removing the soft tissue from inside the wound. The goal is to get to healthy tissue. Which means, bleeding. Scrapping the tissue areas and the bone of as much dead stuff as possible took a little while. But when she was done, the entire wound looked better - if you can call a gaping hole in the body better.

She then measured. 5.4 x 5.1 x 2.4. There is definite improvement. Victoria complained that her big toe was irritated yesterday and we brought it up again today with WN. She looked between the toes and proclaimed: athletes' foot. Between the big toe and second toe. We talked about treatments and methods, along with casting issues. I don't like the toes being so buried in the cast - obviously a problem - and both CT and WN like the protection to the toes it offers. There wasn't much compromise and the new cast extended to the tips of the toes. There is gauze between the toes right now, but I will remove it and use Q-Tips and some powder to treat the condition/infection. I don't like that I can't even see her little toe. After the cast was on, I complained about the lack of access to the last three toes and CT removed a sliver of cast to give me better access. He removed about 1.5" at the side, tapered to the middle toe. It is still not enough and next cast will leave more of the toes exposed. Their concern is that she will stub her toes, but given the limited amount of walking and where she does walk, the danger is minimal.

We left and went home. There I noticed that Victoria is not walking on the whole slipper. Her toes are in the air which means her heel is supporting all the weight. Not good. We tried a few different ways of doing things but it is persisting.

3:45pm
We arrived back at ID for IV. I asked if the IN could call down to CT and see if we could talk about the cast. CT came down while we were waiting for the IV meds to arrive. They are not ready, prepared, until we arrive and are in IN.

CT came down and we talked. He actually was pretty defensive but we agreed that if the issue persists, we will get some cast adjustments done before the weekend. I don't want her to be walking mostly on the heel all weekend.

No IV issues today. We were done in 30 minutes and got ready to go. Although we don't know the exact numbers, IN told us that both blood and kidney numbers had improved on the last blood draw. They were not great, but definitely moving in the right direction (blood 7.3).

They were definitely frazzled there today - no blood pressure or temperature taken!

Home bound we went into the pouring rain.