tag:blogger.com,1999:blog-19832010606275605992024-02-06T23:45:23.133-06:00A path towards heelingOur daily dealings with a severe diabetic ulcer and the medical worldTracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.comBlogger51125tag:blogger.com,1999:blog-1983201060627560599.post-54812624349168840292008-06-17T10:48:00.002-05:002008-06-17T11:01:21.000-05:00Catching upIt has been a while since posting, my apologies.<br /><br />Victoria came off the IV antibiotics and started on oral ones. To the tune of 16 pills a day. It turned out that she could not tolerate them all. We have, after talking with DrIV#2, stopped taking one of them - the 12 pill a day one that cost a ton. CJ and I have a source of antibiotics for the next decade....although they will expire long before that.<br /><br />Cast changes have continued. WN was away for 2 changes and her nurse assistants did wound dressings but no cleaning/debrieding. It was good to get her back last Thursday. Our regular CT was out too so we had the first CT that did Victoria's cast do a couple. He did a fine job, but the casts were larger than in the past.<br /><br />I will post a picture of the wound today - in this post. The size is 5 x 5 x 1.6cm deep. There is also now two places on the wound where the skin has attached to the underlying and new tissue. This is VERY good. Where Victoria was missing 12-13 cubic cms of tissue before, she is down to 1-1.5 cubic cm. The wound is almost completely filled in. Now comes the hard part of getting it to heal over.<br /><br />Her heel is forever deformed. The bone is higher and moved a little to the left. Special shoes and at least a cane will be necessary in the future.<br /><br />The last x-ray was reviewed by a radiologist. The bone shows no further damage and it is showing signs of re-mineralization. The bone is healing. Great news.<br /><br />We will not see DrIV#2 until the end of the month. So things are into the long grind of healing.<br /><br />We received the bill for the first 9 weeks - $42k. We have not heard back from the provider on the care program we applied for.<br /><br />The PICC has been removed. That is the semi-permanent tube and connection for the IV and blood draws. The removal was quick and painless - although Victoria said she could feel it coming out. 44 cm of tube - it reminded me of the commercial on the Sci-Fi channel where the guy was pulling a hair and unthreading his body...<br /><br />Her inflamatory numbers were stable, no real change after 2 weeks of the orals.<br /><br />Next update will be near the end of the month after the next blood work and x-ray.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com3tag:blogger.com,1999:blog-1983201060627560599.post-23030720414051274752008-05-21T17:31:00.002-05:002008-05-21T17:44:04.640-05:005/211:45p<br /><br />Appointment with DrIV#2. I had already seen the x-ray from Monday. I will post it tomorrow with the updated wound picture. We are officially off the IV. The PICC will stay for another 2 weeks to see how the oral antibiotics go. The antibiotics are Doxy, one twice a day, cibro, two twice a day and ciplo, 3 four times a day. In addition to her other stuff. The big deal is no dairy 6 hrs before and 2 hrs after the cibro.....will make feeding Victoria - always a problem, much worse.<br /><br />Dr suggested a year on this course of antibiotics. We will see the cost soon enough, I go to Walmart later.<br /><br />I left to get CJ and Victoria went off to infusion. There is an antibiotic they add at the end when a PIC is not going to be used daily. Working out a schedule for dressing change and such took a little time. We will be back in IN on Tuesday. SLEEP IN WEEKEND!<br /><br />We picked up some ice cream....Victoria will not be having much for a long time.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com6tag:blogger.com,1999:blog-1983201060627560599.post-14612083431186608572008-05-21T17:24:00.002-05:002008-05-21T17:30:06.951-05:005/201:45p<br /><br />Earlier appointment to see if we could get in and out before CJ got out of school. Didn't work...almost! Infusion was fine, and blood draws for her weekly tests had no problems through the PIC. I had to leave and come back, found her crying. Everyone was walking around with their heads down...what the hell?<br /><br />Victoria said it was just a passing thought that made her think of her mother. We left and talked about it later. Short story, she missed her mom.<br /><br />Went home.<br /><br />5:10p (ah ha! surprised you....) <br /><br />CJ had an eye exam. Glasses on order. A tad nearsighted. She is VERY unhappy about needing glasses.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-49383640876826936742008-05-21T17:18:00.002-05:002008-05-21T17:24:21.166-05:005/1911am<br /><br />Cast change. We took pictures last week, so I am going to wait until Thursday's cast change to update those. Cast off, then X-ray, then cleaning, then new cast. Wound looked good but is not shrinking fast enough for me. The zinc helped the foot skin tolerate the moisture much better. The irritation was gone also. WN got a nice bunch of gunk out and the wound was very bloody. For the first time, it looked and acted like a hole in the body, red and bloody. Made me just a little erpy.<br /><br />Still. All continues to progress. I will talk to WN about promoting closure on Thursday.<br /><br />We did infusion right after the cast change so we didn't have to come back later. Numbers fine.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-75438899179309711452008-05-21T17:13:00.002-05:002008-05-21T17:16:09.220-05:005/16, 5/17-5/185/16, 3:45p<br /><br />Infusion was fine. BP and temp normal.<br /><br />5/17, 9:30a YEA, sleep in!<br /><br />Ok...so, we got there, very busy, in and out, no issues. BP in the low 130s. Temp normal.<br /><br />5/18, 9:30a....see last entry!Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-25597988561439677332008-05-16T12:22:00.003-05:002008-05-16T12:27:57.384-05:00Picture update and X-raysTo those with a strong stomach, <a href="http://diabeticheeling.blogspot.com/2008/03/pictures.html">I have updated the pictures</a>.<br /><br />I have also added a <a href="http://diabeticheeling.blogspot.com/2008/04/x-rays.html">post with the x-rays</a>.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-38542222896425626772008-05-16T11:05:00.003-05:002008-05-16T11:06:57.349-05:005/153:45p<br /><br />Simple infusion today, no problems. Victoria had a little issue yesterday with a temp, or not. They took her temp 3 times, got one high (100.1) reading, and 2 normal readings....go figure.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-10622023057981964832008-05-16T11:02:00.002-05:002008-05-16T11:05:21.723-05:005/1411am<br />Cast change. Very goupy and it is clear that 5 days is too long. There is irritation showing on the skin where it has been wet for too long. With WN we agree to return to the Monday/Thursday routine starting on Monday 5/19. The risk is too high for further tissue damage or additional infections. She did another heavy scrapping making it all look like hamburger but also did a big scrap on the edges of the wound...hoping to resume the strong tissue growth we have been seeing. I have pictures too. She added some medication to the irritation areas AND added extra medication to the same areas to prevent moisture from penetrating. (the stuff they put on noses...the white stuff)<br /><br />3:45p<br />Infusion. We talked about timing - we are usually the last ones of the day so we are going to try to come a little earlier next week -which, hopefully, will be the last week of infusion IVsTracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-77319675873369766612008-05-16T10:58:00.004-05:002008-05-16T12:29:35.993-05:005/13Odd detail about yesterday (5/12). Victoria had to appear at a couple of hearings (341's) and was in her wheelchair. The trustee was so polite I had to wonder if he had been body snatched.... The hearings were the easiest, most cordial I have ever witnessed with him. Bizarre.<br /><br />Infusion. Slam bam, thank you maam. Done<br /><br />And a piece of good news. They were able to get blood out of the PIC so they did not need to draw from a new site.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-2031234759394202512008-05-16T10:36:00.004-05:002008-05-16T11:12:34.475-05:005/8 to 5/12I apologize for leaving this unattended. Between dealing with the issues raised with DrIV#2 on Wednesday and being busy, it has slipped. Let's catch up.<br /><br />5/8<br />Infusion was fine. They changed the dressing on the PIC line and her BP and temp were ok.<br /><br />Cast change also was fine. Very goupy in the old dressing but it looked good. The edges seem a little less growth oriented and we talked to WN about scrapping them next time if they stay the same. The depth measurement is all over the place, 1.9, then 3.9, then 2.4, now 2.6. We are not sure what to make of it, only that it is clear things are improving. Pictures posted shortly. I also, after having a chance to think of it, want to look at the x-rays again. I asked one of the nurses that work with DrIV#2 if I could see them again, she said they could be viewed tomorrow (5/9). We were both somewhat subdued dealing with staff.<br /><br /><br />5/9<br />Just infusion. I had hoped to see the x-rays today, but they 'need a doctor's order'. Which is stupid...they are OUR x-rays. It was suggested that I go to x-ray and ask them directly, which I did. After a long song and dance about HIPAA (this is the law that protects your medical records from unauthorized disclosure) in which the x-ray supervisor VIOLATED HIPAA repeatedly, she brought up the x-rays with a release form. She also demanded a photo ID of Victoria - which we seldom have with us. One of ID staff vouched for Victoria but the x-ray person said that wasn't good enough...the IV stuck in her arm could be someone else....I promised to bring the ID on Monday.<br /><br />5/10 and 5/11<br />Infusions at WEC, no problems. BP is again lower here than the weekly readings in IN. It has to be the early time (8am vs 4pm during the week). The PIC line dressing area is irritated and bruised. The mesh they put over the dressing keeps rolling, is too tight and keeps getting snagged on part of the PIC line. (I will post a picture in the next week of the PIC line). IN changed to dressing to move it away from the irritation. But we have stopped using the mesh (which seemed to be fine for 5 weeks) and started using a light compression sleeve the CT use. The irritation looks like a rug burn. I put some lotion on it when we got home.<br /><br />5/12<br />3:45pm<br />Infusion. I had staff call down to x-ray for the x-rays and they said they would be up at the end of Victoria's treatment - why wait??? We had to call down again when she was done as they had not shown up. When she did arrive, I showed her the ID, she gave the release to Victoria to sign and then asked for the ID again to check signature(??). I said NOTHING. It was noted by the IN staff.<br /><br />Ms x-ray storage person: You talked to me about Victoria's x-rays. This was two violations of HIPAA - talking to someone other than the patient and acknowledging that in fact Victoria WAS a patient. You did this for almost 15 minutes. You then discussed the x-rays with someone you didn't KNOW was the patient. Next time you CYA, you better use something better than a single piece of TOILET PAPER. stupid idiot.<br /><br />I also apologized to BugN. She didn't seem to understand why, and I was not able to keep it together enough to explain. We see her on Friday...we'll see if I can do it then better.<br /><br />We took the x-rays home and I will post the pictures of them shortly.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-59946992773818717932008-05-07T19:30:00.002-05:002008-05-07T20:01:03.755-05:005/7This will be a difficult post.<br /><br />3:30p<br />Arrived at ID for an appointment with DrIV#2. The x-rays were available and we got into a room quickly, but had to wait.<br /><br />He came in and had the x-rays in hand. He looked at them and said, that it was very bad. I said I had seen them and thought it was difficult to see where the problem was. We began to talk about the future and what our options were.<br /><br />[warning signals started going off in both of us]<br /><br />He asked again if we had talked to a surgeon. We talked again about DrSur's options. He wanted to consider where to go from here. We talked about being against the amputation. And then, in a very round-about way, he said, it was inevitable.<br /><br />!!!!!!!!!!!!!!!!!!!!!!!!<br /><br />WHAT? He suggested that our current course of treatment was just delaying the inevitable and that we needed to consider the amputation. <br /><br />We were both VERY upset. He took me out to show me the x-rays in the hall on a light board. He put up the x-ray from 3/26 and the one from Monday side by side. I pointed out the recent one was not a good xray because of the distortion on the back of the heel. Then he pointed out the outline of the bone.<br /><br />OH SHIT. It was not distortion. The heel bone looks like it exploded. Where in 3/26 there was a small (raisin sized) bright spot on a well defined bone (pointing at 7 o'clock), more than half the bone looked exploded to 3 or 4 times the size, diffuse edge and pointing at 9 o'clock. Devastating.<br /><br />We returned to the room with Victoria who was crying.<br /><br />I will not be able to recreate a conversation that lasted almost 90 minutes, but I flat out accused him (and his staff) of failing in their effort to contain the infection. We talked about a number of options, but in the end he had two specific things to say:<br /><br />1. This infection will, in the end, cost Victoria her foot. We might get it healed, but the infection will ALWAYS be in the bone just waiting for another opportunity. He agreed we may have a 15-20% chance of getting it healed, but the infection will never be 'cured'. He repeated, several times, that a 15% chance of healing, means a 85% of failure. We repeated that amputation was a 100% chance of failure.<br /><br />2. This infection will, in the end, kill Victoria. It might take a long time, but probably within the next 10 years, she will die and this infection will be the point we will look back to as the first fight in the war. <br /><br />He will do everything he can to give us the best chance of beating the odds, but we need to be realistic. He wants us to deal with the reality that Victoria's foot will be amputated at some point. At best, we are giving her some more time.<br /><br />I took those comments and inferences to mean he was just biding time, but he wanted us to know that was not his goal. He wants Victoria to be healed, but the nature of the beast is that it will never be cured. At some point in time, she will get another infection or this one will flare up again.<br /><br />During this time, IN came in and gave Victoria her infusion. He gave us some time to talk while he saw someone else for a short time. When he came back, he said he was going to review the cultures and Victoria's numbers and come up with a oral antibiotic treatment that will, hopefully, be as good, or better than the current IV treatment. This is to help reduce our costs - which got us going on the idea that we didn't want cheap, we wanted the best. He argued that was his goal and that he would not sacrifice Victoria's care in any way because of cost.<br /><br />For the moment, we will continue with the IV for another 2 weeks and get another x-ray. If things hold the way they are, great.<br /><br />Understand, the issue for me is the trend line. It appears, for now, that the infection and wound are not getting worse, they are stable, they will never be cured. As long as the trend line down has been broken, I am happy (ier).<br /><br />We left at 5:30. The building was deserted (it closes at 5) and we both cried most of the way home.<br /><br />We picked up dinner. CJ is out for the evening fishing with Sue. Right now, we are both calm, but this is not over.<br /><br />Pray.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-33770428259834314272008-05-06T18:06:00.002-05:002008-05-06T18:34:40.768-05:005/610am<br /><br />Arrived for appointment and checked in at X-Ray also. We had seen DrIV#2 for a moment yesterday and he agreed to come down and look at the wound when the cast was off. CT got the cast off and we waited for X-Ray to come get us....which happened within 5 minutes!<br /><br />Into the X-ray room and the tech asked me to go sit in the waiting room, I declined and said I would wait in the hall. They let me in a few minutes later while they checked the films. And, of course, they needed to redo one and asked "do you mind waiting outside?" I said, "yes, but I will comply." We were done and left nicely about 5 minutes later.<br /><br />Returning to the cast room, CT got Victoria up and ready for WN. DAMN the wound looks great! Good improvement even though the cast was on an extra day.<br /><br />The cast SMELLS bad and the slipper was very wet from seepage. But the wound was great. WN measured and noted that she found the wound was deeper than originally thought, after a little change in angles, the wound is almost 4 cm deep. She believes it has always (the last month) been this way but it was hard to find till the wound was completely clean of dead tissue. Despite the depth, she said she felt the wound was progressing very well. DrIV#2 came in right behind her and got a chance to look. He glanced at the x-rays also. We will meet with him longer tomorrow.<br /><br />WN then took out my favorite tool, the round scapel with a hole and proceeded to scrape every surface of the wound. When she was down, it did look like healthy....hamburger. A little of the bone was still accessible so she worked on it too.<br /><br />After packing the wound with poop (the brown enzyme) and getting the wound covered, we talked about the schedule. Normally we would be in on Thursday, but there is no reason to go back so soon. However, waiting til Monday means 6 days. 5 days stretched everyone's comfort zone so we planned on returning Friday. But WN did agree that 5 days might not be a bad period at this point. So, starting Friday, we will do next Wednesday, then the following Monday, then Friday then Wednesday and so on. Maybe a month or so of that and then we see.<br /><br />One issue that is becoming apparent, the tissue in the wound is not as attached to the growing skin cover. This might happen over time, but the two items are not growing much together. WN noticed also, but said it was impossible to predict exactly how each wound will heal.<br /><br />I did not have the camera with today, so we will have to wait til Friday for the next look.<br /><br />CT got a black cast on and we left. Victoria had lunch with Sue while I went off in search of a self-propelled mower. (hey, I am getting older, a little help would be nice!)<br /><br />3:45pm<br />Arrive at IN. PIC dressing change day; blood draw for tests day; IV first, then changing the dressing. All fine. BP a little high still 150s. No temp. When the IV was done, they tried to draw blood through the PIC...no go. Damn. Lab was called to draw the blood which happened quickly and 'easily'. We were done by 4:45 and headed home.<br /><br />I have rearranged the garage so Victoria doesn't have to go around the car door going in and out...don't know why I didn't do is sooner.<br /><br />Tomorrow we find out how much longer on the IV.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-39214154991243524282008-05-06T18:04:00.003-05:002008-05-06T18:06:41.687-05:005/5Checked the calendar Sunday night and it didn't have a time for cast change on Monday. We had early court so I planned on calling as soon as we got to the office after the hearing. Which I did. No appointment for today in the cast room....as a matter of fact no appointments EVER again in the cast room. This is not good. After some calls and best efforts, we got a 10am for tomorrow (Tuesday).<br /><br />3:30pm<br />Infusion was fine. BP back up towards 150. No temp.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-1356075283986365862008-05-06T18:00:00.002-05:002008-05-06T18:04:12.939-05:005/2, 5/3, 5/4Friday, 3:30pm & Saturday , 8:15am & Sunday, 8:15am<br /><br />I am bunching these up because with no exception the appointments were in, out. No fuss, no muss. I did see DrIV#2 on Friday and he agreed that getting an X-ray of the foot when the cast was off prior to our appointment with him on Wednesday was a good idea. He put the order in (and then I found out he was off and had come in on his own time). Sorry doc.<br /><br />Temps and BP have been fine, as a matter of fact, over the weekend, Victoria's BP was into the 130s.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-5354840988103135462008-05-01T17:16:00.002-05:002008-05-01T17:26:16.065-05:005/12:00pm<br />Cast change. The timing of today's cast change meant I was not going to be in the room when WN did the check and pack. I did notice that two spots where I had taken Victoria's blood sugar on her wounded foot have not been clean pokes. No more blood tests from that foot. (WN agreed!) CJ and I got back just as CT was beginning to work on the cast...which I thought was going to be red and black. In honor of that color scheme, both Victoria and I were wearing black shorts and red t-shirts. Apparently the fix was in....purple and pink.<br /><br />The wound is...interesting. When Victoria is out of the cast, her foot does a lot of moving. This is good as it helps with circulation. Her leg and foot always look dark when the cast first comes off but it pinks up nicely in about 5 or so minutes. Part of the reason is that her leg is held in place and so the muscles don't aid much in the circulation. Her leg has to rely almost entirely on the circulation system. The previous packing was very goopy and had noticeable blood staining. None of this is bad. However, it does make Victoria's foot feel a little like she is walking in mud. The wound itself has begun 'sticking its tongue' out. When Victoria flex's her toes up, the tissue in the wound...well, it sticks out of the wound. Not much, but from the side....<br /><br />Cast change done, we went off to IN. Maybe I shouldn't have, but I did note to the IN staff that I don't like BugN. From the looks passed around, I either said something really bad, or something well known. Victoria thinks I said something bad. I said I had no problems with the staff (in as much as their professionalism and their caring), just I had some disagreements. <br /><br />IV went smoothly. BP just back over 150. Temp ok. The weather was nice when we went in, not so when we came out.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-69577945025448167592008-04-30T18:03:00.001-05:002008-04-30T18:45:24.652-05:004/30A full month has passed. The most recent photo, from Monday, is <a href="http://diabeticheeling.blogspot.com/2008/03/pictures.html">here</a>.<br /><br />Some observations. We have met some great people, especially the IN staff and WN. CT has been equally great. The admin staff is polite and friendly, we seldom 'check in' as they see us coming and get us logged in with almost never a wait. We try to be on time for appointments and it is great that we seldom have much if any wait.<br /><br />The doctors. Frankly people, you need to work better. DrPRI has recovered some from her earlier hysterics and the numbers from yesterday's blood tests will (HOPEFULLY) end them. DrIV is as cold as ice. We have only seen him twice and that was 3 times too many. DrIV#2, off to a good start.<br /><br />I have not always been polite, and frankly, am a pretty forceful advocate for Victoria. In most cases, the result has been good. Last word before today's report card: WN is worth her weight in gold. The medical group that she works for owes her a debt a paycheck and gold watch can never, ever repay - and neither can we.<br /><br />3:30pm<br />BugN appointment to go over the blood work up and prescriptions. We still have another 10-20 days of IV but we didn't discuss it much. Renewed the prescription for the oral antibiotics and suggested that the iron supplements may be having a negative impact. I didn't tell her, or Victoria til later, I stopped the iron when Victoria started having 'issues' (constipation). Here are the results of the blood work:<br /><br />Comparisons are yesterday to 3/27 tests:<br />Creatinine 2.2, up from 2.6 (this measures kidney function and lower is better)<br />Hemoglobin 8.8 up from 8.2 (this is the anemia indicator, it is up from 7.1 on 4/1) GREAT!<br />Sed rate 93 down from 120 (an infection marker that is down, still high but trending)<br />CRProtein 26 down from 151 (the other infection marker, another good move down)<br /><br />There are more than a dozen tests reported and all of them show improvements and positive trends.<br /><br />The time with BugN was short and pleasant. Off to IN and IV<br /><br />Got situated and started. Oh. BP is 142 and temp normal. 32 minutes later, all done and head for home. We were told that we get to sleep in over the weekend; Victoria's IV appointments were both moved back from 8am to 8:15am. Great huh!?!Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-91747902679908593702008-04-30T17:52:00.002-05:002008-04-30T17:55:45.591-05:004/293:45pm<br /><br />Fear is realized. Victoria's PIC line has developed a minor blockage. IVs can still go in, but they can't get blood out. There is a chemical they can use to help unblock, but the cost is over $500 per dose and if Victoria is willing to be poked once a week, they will continue without drawing blood from the PIC.<br /><br />For the moment, IVs are going in and they did today. Blood was drawn so we will see what the numbers are like tomorrow.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-54028299901674614482008-04-28T21:33:00.002-05:002008-04-28T21:45:11.496-05:004/26-27, 4/284/26 8am<br />Yes, wonderful time to get up on a Saturday and be out and about. Got to WEC, got IV, temp and BP ok. In and out.<br /><br />4/27 8am<br />Yuk. CJ hated getting up early and going to WEC and then to church. But, we got in, took a 10 minute nap each and got out. Staff was busy both days so there was little chit-chatting going on.<br /><br />4/28 2pm<br />Arrived at ID on time and got in to see CT right away. WN's assistant #2 came in with the ultrasound debrieder. The wound looks very good and it is clear there has been more filling in. No way it is as deep as it was...but have to wait and see. I actually got my nose into the removed cast - OH MY GOD does it smell BAD. The fluid coming out was tinged with blood. This is a good thing (not just in my opinion) as it indicates there is more and more good tissue being exposed.<br /><br />WN came in and smiled upon looking at the wound. She got to work right away. I had snapped a few pictures before she started. The wound is no longer 'round'. It has been oblong for a while, but the shape is definitely changing. 10 minutes of the ultrasound and she was done. I took some more pictures and then had to hurry out to get CJ. I was late, AND IT WAS SNOWING! Not a mix, not flurries, SNOW. Big ole hairy snowball sized wet flakes. CJ had forgotten her coat this morning...to say she was upset that I was almost 10 minutes late...well, she wasn't THAT upset!<br /><br />Got back and both techs were there as one has been working on Victoria for several weeks and he was passing his insights on the other. Purple cast this time around. He was a little heavy around the arch but otherwise, a workable cast. We then went on to IN.<br /><br />We got set up and talked about a bruise on Victoria's neck. Apparently the fall last week has left a mark. The bruise is about 6 inches long by 1.5" wide on the side of her neck. It is healing.<br /><br />BP was 150 and temp ok. IV was smooth but we got there late and got out of there just before 5pm. Caught the rush 20 minutes but was home by 5:25p<br /><br />PICTURES WILL BE POSTED TOMORROW.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-2297344086332087822008-04-25T18:08:00.003-05:002008-04-30T18:49:00.671-05:004/25Last night Victoria complained that the side of her foot hurt. She felt the bandaid that had been put on a spot of rubbing by the cast had come loose and moved, making a rubbing spot worse. As such, we said that if it persisted into the morning, we would go back to CT to have it redone.<br /><br />8am<br />The cast still hurt. We have to go to the office this morning, but I said I would make an appointment with CT.<br /><br />1pm<br />Arrived at ID for cast check/redo. CT was fine with the request and got started on it. I did not believe the bandaid moved - really not possible - but there is no way I am going to dismiss the issue. The possibility of something going wrong is too high and the consequences too serious.<br /><br />The cast came off and the bandaid was exactly where it had been put. Still, we talked about some minor changes and the bandaid was removed and a smaller, more flat covering applied. The cast was redone and as we learn, things improve. This cast is lighter, more stable to Victoria's foot - making it work better - and less tall...preventing her hips from being uneven - a source of discomfort.<br /><br />2pm<br />Moved from CT to IN. I had checked in earlier with IN and they were waiting for us with meds all ready. I still had to leave to pick up CJ, but Victoria was done by the time I got back.<br /><br />Insulin: Victoria had 40 units yesterday and none so far today. At most I expect 30-50 units. Sugars have been in the 100s.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-80294660058981193572008-04-24T17:56:00.002-05:002008-04-24T20:42:20.048-05:004/249am<br />Arrived at ID for cast change and got in pretty quick. CT cut the old cast off and we talked about Victoria's experience. It was a lot heavier and more difficult to walk in, but it did do what it was supposed to do - stop the posting.<br /><br />The wound looked very good. WN came in and agreed. She then started cleaning out the wound. This was in response to the previous comments I made to her. It looked good and she added a new compound to the wound and packed it to the brim.<br /><br />Quick in and out (20 minutes) and the new cast was started - color, black. CT modified it again to get it a little lighter. Still not perfect but by the time he was done, we were almost 2 hours late to IN.<br /><br />10:45a<br />IN put us in a private room and we waited for the meds to arrive (they are called for only once we are actually in IN). BP still a little high and temp ok. Most of Victoria's heart rates are in the low 60s!<br /><br />We got out around 11:30a and got some lunch before heading to the office for a potential client meeting. This was only the second time we used the wheelchair but it fits in all the office doors including the bathroom!Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-12388983107671284532008-04-23T20:41:00.002-05:002008-04-23T21:00:41.098-05:004/233pm<br />Arrived at ID for infusion and appointment with DrIV#2. First stop was X-ray. They wanted a new look at the bone for DrIV#2 to look at. I went in with Victoria. Sue and CJ were tagging along and waited in the waiting area.<br /><br />X-ray Tech was very good but needed some advice on taking a picture through the cast. And given the extra thickness this cast has...that was some doin. Unfortunately, I don't think there was enough contrast to get a good idea what is going on. That said, we got the films and headed for DrIV#2.<br /><br />We have never met DrIV#2 although we had heard nice things about him. We got to the check in right on time...and waited...and waited...and waited......past the time when Victoria was scheduled to get the IV. I went back up to the desk and got the ball rolling. Being a regular helps.<br /><br />Off we went to the only private IV room. We got set up and Victoria's IV was started even before the dr came in. They even had time to change the PIC dressing (a weekly task).<br /><br />Finally, he came in. Nice guy. Introduced himself, got comfy and asked how Victoria was feeling - in a way that suggested, he wanted to know. Discussed how the infection got this bad and the anemia. Sue added that she was concerned that the anemia was not caused by iron deficiency and therefore iron pills may not be useful. While we were waiting, I had one of the IN staff check on the results of yesterday's blood draw. Hemoglobin was 7.6. More improvement!<br /><br />DrIV#2 asked about the surgeon and his recommendations. I offered them. Then he looked at some of the results of the blood tests and said something wonderful. He said he didn't know what was normal for Victoria so it was hard to tell how much improvement was going on, or could go on. YEA! He gets it!<br /><br />Some more numbers: Sed rate. This is how much blood goops. I am not going into the details, not important. Enough to know that when a big infection is going on, this number can be very high. 4 blood tests ago, the number was 151. Today it was 38. This is very good. However, normal might be around 10. What is interesting is this number is UP from 33 last week. Now, BugN was all about the infection - this number is a good indicator of a bad infection and it was DOWN 80% last week! What the hell!? Another number deals with proteins in the blood and 4 tests ago, it was over 250. It is 101 today and down from 115 last week. Apparently this number should be nearer 50. So what was BugN going on about infection markers?? Victoria's numbers show dramatic improvement. Perfect? No. But certainly not something to poo-poo.<br /><br />Oh...RA (arthritis Victoria has) can increase the protein markers too.<br /><br />I told the doctor to expect dramatic improvement next week. Victoria's insulin has fallen through the floor. I know I suggested it before, but there is no doubt it has over the last 48 hours. Over the weekend and Monday, Victoria's sugar numbers have been going the wrong way. As a diabetic eats, the sugar levels increase and require insulin to control. Victoria has had low numbers and after eating and no insulin, they have been going DOWN further. Yesterday she got 55 units, all in the evening. This is more than 100 units less than her normal dose. Today, so far, she has had 15 units and she has not moved out of the 100's (very good).<br /><br />With lower insulin doses and better sugars, Victoria's healing with accelerate (hopefully, knock on wood).<br /><br />DrIV#2 really wanted to see the X-ray from 3 weeks ago, but they couldn't pull it out of anywhere. That said, he wants to look at it and see Victoria in 2 weeks. He would also like to see the wound when it is open. We will see if it is possible during cast work tomorrow.<br /><br />We both like him. Sue agrees.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-85210336923577312082008-04-22T18:14:00.002-05:002008-04-22T18:23:34.626-05:004/22Morning:<br /><br />DrPRI's office called. She is concerned by the low blood count.... (are you rolling your eyes...again?!)<br /><br />"Yeeessssss..." said I.<br /><br />"The doctor wants to try and find out where Victoria is bleeding. You said she was not bleeding from the heel wound..."<br /><br />"Said? There have been more than a dozen cast changes, a surgeon has looked at the OPEN wound and THERE IS NO BLEEDING OUT."<br /><br />"Yes, well, the doctor wants to try and figure out where she is bleeding from...."<br /><br />"She ISN'T bleeding from ANYWHERE!"<br /><br />"Well, her blood count is low.."<br /><br />"Yes, because **** Medical gave her a drug that CAUSED the anemia to get worse, but as I am sure the numbers you have indicate, she is recovering from that mistake."<br /><br />"Yes, but the doctor..."<br /><br />Wants a colonoscopy. No thanks....did that 2 years ago....the likelihood of a big change occurring since then is pretty small as there are NO risk factors. AND....there is no indication in her stools of anything wrong there.<br /><br />I ended the conversation. And, another nurse called 2 hours later, saying that DrPRI still wanted the test done. I said no and hung up.<br /><br />3:45pm<br />Arrived at ID for the IV at IN. (sheesssh). Got the weekly blood draw done so that DrPRI can have another hysterical afternoon tomorrow..... Otherwise, easy afternoon.<br /><br /><a href="http://diabeticheeling.blogspot.com/2008/03/pictures.html">PICTURES have been updated</a> view at your own risk!Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-40487274882521732802008-04-21T23:03:00.002-05:002008-04-21T23:18:20.459-05:004/212pm<br />Cast change. Got in and set up. CT got the old cast off and we talked about changes to the cast to improve things. He has an idea for a change and we agreed. He is going to add the little ridge further back on the heel. I think this is a good idea.<br /><br />WN came in with her ultrasonic toy. Her assistant is....well.....I need to come up with a blog name for her. I told her I was trying to think of one but she didn't offer a suggestion. WNA doesn't seem right. AWN doesn't work either. Will have to give it some serious thought.<br /><br />WN got to work. Victoria had to talk to the Court during the session. Everyone was quiet, but kept working on Victoria's foot during the call!<br /><br />After the debrieding, WN measured the wound. It was clearly smaller but....da da...<br /><br />5.1 x 4.7 x 2.4<br /><br />It is clearly improving. I haven't posted last weeks photos' and now I have today's too. I will get them up in the next day.<br /><br />After she was done, we talked about BugN and the infection. She agreed with BugN but understood our position. We talked on several things and we kept her well past the time she should have spent with us. She was great.<br /><br />She left and CT started on the new cast. The ridge was replaced with a lip. That is the only way to describe the 1/2" tall x 1/4" thick by full width 'lip'. After it dried and Victoria tried walking, it was clear it wasn't going to work as well as planned. he added another 1/2 under the toes and that worked better. But the cast no looks like those platforms Chinese wear?<br /><br />I am concerned for the hip displacement caused by the height addition. We will see. He had to trim some of the lip off to get it balanced, but Victoria said it is ok.<br /><br />We were more than two hours in the cast room and were very late to IN for the IV. Once in IN, Victoria said she wanted one of the recliners - normally she takes the IV while still in the wheelchair we use there. Not today. Comfortable chair for her. IV went well. Blood pressure still elevated. We will try an experiment on that this week. Temp ok.<br /><br />We left at about 5:20 and picked up CJ from Sues. Hot dogs was the choice for dinner, so after getting Victoria settled at home, CJ and I went shopping. <br /><br />Anyone know where we can get Big Johns beans?Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-60086469947334363442008-04-21T21:10:00.002-05:002008-04-21T23:03:42.072-05:004/18, 4/19 and 4/20sorry about the delay.<br /><br />Friday: Victoria fell again overnight. It was very hard to get her up and her neck was seriously stressed. This is the second time this week and we need to address the issues causing it.<br /><br />3:45pm<br />IV went well. No issues.<br /><br />Saturday, 9am<br />IV at WEC. Talked to IN about the falls and BugN's pronouncements. No issues. I went to Milwaukee and met someone selling a wheelchair. The price was good and it is a sturdy, wide model. AND, it fit in the trunk perfectly! Just need a cushion for it. But Victoria tried it and it works great and she likes it!!<br /><br />Sunday<br />Victoria slipped off her recliner overnight. This is the third 'fall' in the last 5 days. I would say we are getting better at getting her back up, but it still took almost an hour and she still stressed joints. This is NOT something we want to get better at.<br /><br />9am<br />IV at WEC. Then off to church and Victoria's first use of the new chair. Worked fine.<br /><br />1pm<br />Our good friend Nene offered a lifting recliner to us. Which we gratefully accepted. She and a friend delivered it today. After some re-arranging of the living room, we got it in and set up. This will make it much easier for her to get out of the chair overnight to go to the bathroom without the risk of falling.<br /><br />THANK YOU NENE! It is working great.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0tag:blogger.com,1999:blog-1983201060627560599.post-47319571242620825262008-04-17T17:50:00.002-05:002008-04-17T18:00:15.499-05:004/171:40pm<br /><br />Odd time for cast change. Victoria did a shower last night with the cast on, we did lots of things to try and keep it dry, with less than 100% success. Still. The cast is leaking like a sieve. Fluid is seeping out and into the slipper.<br /><br />CT took off the cast and got it ready for WN. She came in and we discussed the issue. One option is to switch back to 3 changes a week. Victoria's foot was white and wrinkled. The bottom of her foot had been damp for too long. Her foot is also peeling. This happened with the toe ulcer too, but the area is much larger. WN removed the excess peeling skin. It is similar to a sunburn peel.<br /><br />The fluid seeping is likely caused by the amount of fluid that is in Victoria's legs. I have been trying to get her to keep her feet up as much as possible but she refuses. By this time on the toe ulcer, her ankles were showing. There has been NO change in the amount of fluid in her legs since this started. It is clear that the fluid is finding it's way out the heel wound. This is NOT GOOD for tissue healing. Victoria is also getting weaker in her legs. I think the two are related.<br /><br />WN said she would try a few different things to see if it helps reduce the fluid seepage or at least protects Victoria's foot from too much moisture. We will have to see. She added new ointments to the wound and packed it extra. Cast is blue!!!<br /><br />We were out just before 3 and headed for IN.<br /><br />We got set up in a separate room than the general area. No biggie. Blood pressure still a little high and temp ok. IN went to wait for the IV fluid. After 20 minutes, I went looking for them. Apparently, the IV got lost and they forgot about us. She brought the IV a little later and got us started...40 minutes after we got there. Everything went ok and we were out by 4:25p<br /><br />Another weekend coming.Tracy Coylehttp://www.blogger.com/profile/13396494193507308556noreply@blogger.com0