Wednesday, April 2, 2008


First up this morning, 8:20 at ID, orthopedics to remove cast and have WN check progress. The tech got the cast off and surprisingly the leg sores looked better. Her heel was goopy and the packing shows the depth of the wound to be about 1.5", from side to side and from the back of the heel to the beginning of the arch. I will take a picture of it next chance so we can see progress. The wound actually looked good (though I am sure anyone else looking at the gaping, dripping hole would differ with that assessment.

WN came in and she visibly brightened upon looking at the wound. It hasn't gotten worse, which is an improvement. She seemed more positive about the future. She packed the wound and dressed it. We scheduled coming back for a new cast after we see the surgeon about 1pm....more after that.


Arrived a little late because I went to the wrong place. Still, we got in and after filling out another 'intake' sheet, got settled in an exam room. The nurse took off the dressing put on by WN earlier. It was bloody. Not terrible, but it was obvious that Victoria had done some stepping on the foot without a cast. It sat there dripping while we waited for DrSur. He walked in and introduced himself.

He got down on all fours and peered at the wound for more than 5 minutes. He then sat down and offered the following:

1. Amputate mid-calf. 70% chance of healing but it might be much lower chance if the tissue of her leg is not completely healthy - and he acknowledged from his inspection, it was problematic.

2. Amputate a chunk of her heal and extend a tendon in the back of her leg over the opening - IF she can be in a rehab facility for 3-5 months and not walk on the foot AT ALL during that time, 50% chance of it healing.

3. Keep doing what we are doing and there is a 15-20% chance of getting it healed.

#3 is 3 times greater chance of success than I had given it, so that is great!

We thanked him for his time and the speed at which he saw us (getting an appointment in 2 days was wonderful). We left and picked up CJ before heading back to ID and casting and IV antibiotics.

We tried to get her IV antibiotics and they wouldn't do it because her kidneys are having a hard time with them and they want to switch to every other day. By the time we had talked about the issue with DrIV and WN and the infusion staff, we were scheduled in Casting. The issue with the kidneys is a problem. Victoria only has about 25% kidney function anyway and anything that makes that worse is BAD. But, there was another issue: While we were in with DrSur, the phone rang twice. I ignored it, but checked in when we left to go get CJ. DrPri's nurse had called and asked for an IMMEDIATE call back. Which, we did. Apparently, the blood test on Tuesday scared the piss out of her. DrPri said Victoria had to go to the hospital immediately because she was acutely bleeding.

Now, remember. This is based on a blood test taken about 24 hours earlier. On this day, we have had WN go over the wound, a surgeon look at Victoria, and the ID staff including DrIV visit with Victoria, someone might have noticed any pooling of blood., somewhere. We declined to run to the ER, but then Victoria agreed to go to the ER to be evaluated. We finished the casting but DrPri called to say that the hospital staff were ready for us and a room was ready. HUH? I asked Victoria if she had agreed to be admitted to the hospital. She said no. I called DrPri back and left a message to call.

We decided to go to the hospital for the evaluation, maybe a transfusion. (The blood test showed very low red blood cell count - 7.1 when 10-12 is normal, Victoria's normal is around 8) When we got to the hospital, they wanted to admit her to do the evaluation. DrPri called when we were at a room reserved for Victoria. I was pissed. I said Victoria NEVER gave agreement or permission to be admitted. She wanted to talk to Victoria, Victoria didn't take the phone but did tell her that she had not agreed to admittance. She said she would call the ER to see if they would evaluate and transfuse Victoria. I hung up. We started to leave the floor and the nursing staff stopped us, asked us to wait while they called the Admitting Dr. After a 5 minute call, head nurse? said that Victoria had to be admitted. We said no, give her a transfusion and evaluate in ER. It was a scene at the nurses station and CJ was upset we were making one. But I was firm. No admittance. If they would see us in the ER, fine. They said no so we left the hospital.

Victoria is on multivitamins and extra iron supplements. Her color is fine, no stool or bladder issues. There are no unaccounted for bruises ANYWHERE - I checked. Except where the PIC was installed and that bruise is healing fine. She is actually more alert than usual this week. (No big naps and when she does take one, she is lucid and clear of where she is and what is going on after waking.)

The day started good, finished bad. We discussed whether we could keep DrPri. She has overreacted and has not listened to us. We have been clear, there would be no admissions to a hospital for virtually any reason. If Victoria and I decide that is appropriate, fine. Or if something substantial happens and Victoria is unable to decide, I have her Medical Power of Attorney. But 'acute bleeding' is hysteria. And 'admitting' Victoria without her consent....may have been a final straw.

We will see what happens tomorrow.

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