Monday, April 14, 2008


Arrived at ID for cast change. Got in about 8:20a. Cast came off and we saw staining of the slipper under the cast again. This is a little disturbing but...

Wound looks good. I will post 2 pictures from this morning later tonight or early tomorrow. The wound has shrunk by about .1 cm in width and .2 cm in depth. This is a good thing. WN liked the appearance and condition of the wound. WN had her trusty new ultrasonic debrieder and went to work. After 10 minutes, she added a new enzyme to the wound that would continue working on dead tissue and help promote tissue growth. Once packed, off she went.

We discussed the cast with CT and decided that less was better and the bottom of the cast would be flatter than the last one. It is obvious that Victoria is 'posting'. This means that she is actually standing, in the cast, on the heel. Instead of her weight being evenly distributed over the foot, her foot is actually toes up. So, by having a flatter cast, she might post less. When he was working on the toes, I had him make sure that all the toes were visible from above so that I could have access to them. When the cast came off, I actually trimmed Victoria's nails.

When the cast was set, Victoria stood up...and posted on the heel. He took a pen and taped it to the bottom of the cast and immediately, Victoria stood flat footed in the cast, YEA!

He added a ridge to the bottom of the cast and she has been walking with a much more natural, and flat gait all day - not that she is walking a lot, but it is obvious she is not posting at all.

We made and kept an appointment with DrPRI. Never have I seen a doctor back-peddle as much as she did. "You are the boss" "I am only a consultant" was amazing and probably the closest thing a doctor ever offered as an apology. We talked about crit and other issues for about 20 minutes. No med changes, but cholestraol and A1C tests are now permanently logged for regular checks. I want to see if the A1C shows improvement. A1C measures Victoria's blood sugars over a long period. If the change we made before Christmas with how we do insulin has improved things, it will show up in the A1C.

After all the blood draws, there has been no cholestral tests. So there will be with the next blood test. Her blood pressure was a little high, but we are not going to make any changes right now.

DrPRI redeemed herself this morning.

Back at ID for infusion. Everything fine, planned on blood draw and dressing change tomorrow. BugN is scheduled for Wednesday.

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