Saturday, October 31, 2009

Visit to the Wound Clinic

With Skip's wound not responding well to the treatment prescribed by the wound nurse, we had to pick up things up a bit. We'd resisted going to see a wound doctor because we had no way of getting Skip up onto a table for an examination and treatment. Skip's wound nurse had worked at a different wound clinic at another local hospital and knew there was a setup there for Skip to get on a stretcher and be cared for. So, she arranged for an appointment there on Thursday.

The atmosphere right from when we walked in was very different from what I'd experienced at other clinics, which were always professional, but never warm. Right from the start, everyone was warm and friendly ... from the receptionist to the intake nurse to the wound nurses to the doctor himself, it was a great team. The intake nurse had an excellent means of transferring Skip from her chair to the treatment table using a sheet until Skip's knees and a bit of strength from the nurse and me.

The wound nurse gave us some disturbing news when she measured the wound. She let us know it was 3.8 cm deep. Yikes!

The doctor came in and debrided the wound. We have to go back next week for another round of debridement, with the application of an ointment that will continue the cleanout in between. Once the wound is prepped for healing, he told us they'd use a vacuum approach to promote healing. On Friday, when the visiting nurse came to change the bandage, she was pleased to hear about the vacuum approach since she'd seen great results with that with another client.

I was very concerned about the wound prior to the clinic visit. I'm still concerned but also optimistic about the prospects now that we've got the clinic folks engaged.


awb said...

Hey Cranky, good to hear Skip is getting it taken care of, I knew you guys would. Just wanted to stop in in say hey, and happy Halloween. Catch you next time,


Herrad said...

Hi Cranky,
Hope that the wound will start to heal as soon as it is clean.
Am amazed that Skip can sit as that increases the pressure on the wound.
Thinking of Skip and you alot.

Came by to say hello and wish you both a good Halloween weekend.

Anonymous said...

Hi Cranky. I'm so sorry about Skip's wound, my gosh, reading about Herrad's wound all these months...I can't imagine. I'm so glad you found a decent clinic with caring people, that is rare!

upstater said...

Hi Cranky,
I hope Skip's wound heals with the new plan. I'm glad you found a good clinic. It makes a big difference to be welcomed.

steve said...

I got my lips caught in a vacuum once. Probably not relevant, but funny.

I hope the care plan is working out for you both.

Diane J Standiford said...

I'm glad you two got to see a pro, but I remain angry as H double hockey sticks at places that STILL don't have accessible exam tables!! I wrote about this years ago and STILL is is a problem for disabled and elderly! CNN did a report on it---PEOPLE ARE DYING because they don't go to see Drs., knowing they can't get on the exam table. Grrrrr The battle continues.
(That IS one nasty wound! Send her my hugs.)

steve said...

Good morning, your Wholly Crankiness. I'm jonesing for a cranky rant, but can't seem to come up with one at the moment. Doesn't mean I'm not feeling cranky ... just no triggers here in California yet.

Let us know what the vacuum treatment was like. My geek curiosity is peaked.

Cranky said...

To all - thanks for your notes and good wishes re Skip's wound. We've now been to the wound clinic for 3 debridements and the wound is still not ready for vacuuming. We agreed with the plastic surgeon doing the work that one more round of debridement will occur this Thursday and, then, if it's still not cleaned out, he'd do the cleanout in an operating room so it could all be removed and ready for vacuuming.

steve said...

I found some youtube videos depicting the vacuum therapy process. Geek curiosity satisfied, and I really feel for the two of you having to go through all that additional crap.


Cranky said...

Steve - ya, this is really, really sucky. On those youtube videos, were they gross or did they minimize gross visuals and really focused on education about the vacuuming? I'd like to view them, but not sure I could handle to much wound viewing. I need to feed my inner geek, too!

steve said...

This is the one I watched: It's a stage four wound -- deep but not messy. The narrator sounds a bit like Dolly Parton, which takes some of the edge off.

Cranky said...

Steve - I haven't taken a peek yet. I would love to see but don't know if I can bear to see the wound (though I see Skip's very, very large one every day).

I'm mostly curious how the device will work for a wound at the base of Skip's butt.

steve said...

After the wound is cleaned with saline, a thin, non-stick mesh gauze is lined along the inner surface of the wound. One end of a thin tube is then curled inside the wound, and gauze wet with saline is packed on top. A large sheet of transparent film is then placed over the wound with the other end of the tube sticking out. Care is taken to get a perfect seal around the wound. The tube is attached to a pump to create negative pressure in the wound cavity.

I'll be fine and dandy.
Lord, it's like a hard candy Christmas.
I'm barely getting through tomorrow,
but still I won't let sorrow get me way down.

- Dolly Parton Hard Candy Christmas

Cranky said...

Steve - thanks for the description so I could avoid the visual!

Sandy said...

Dear Cranky,
My husband developed a large sacral wound in the rehab center where he was rehabbing after being paralyzed from the waist down in 2007. We were treated unsuccessfully at a wound center for months before agreeing to the negative pressure wound vacuum. Would love to hear how the vacuum worked for you. It malfunctioned constantly on my husband's large sacral wound. Beeped at all hours of the night, indicating full canister when it was not full, tubing clogged frequently, which meant I had to find the leak and reseal. Many problems.I also had to reposition every 2 hrs. Very sleep deprived. Hubby finally had successful flap surgery. He is still bothered with chronic butt pressure wound,even though I reposition him often and have a top of the line mattress. His butt is so skinny,( wish I could give him mine) that the slightest skin tear or shear turns into a wound. Ask your wound care people about PolyMem. It's definitely the best dressings I've found for treatment and the easiest for caregivers to use.
Been battling my husband's wounds and other health issues since 2007 and I'm elderly, so I know what you're going through as the caregiver.
Many blessings,

Cranky said...

Sandy - thanks for your note.

Skip did eventually go to the wound vac in December '09 and it ended up working very well. Fortunately, we had few leaks or other problems to deal with. If I'd had to be up at night as much as you, I'd have been super cranky!

The major wound healed in May 2010 but sometime after, a small irritation eventually blossomed into a small, new wound in the same general area. She recently started at a new wound clinic at Brigham and Women's Hospital in Boston and they performed flap surgery 1-1/2 weeks ago. The incision is about 4" long and is coming along in the healing. She can't get out of bed for 6 weeks, until the sutures are removed.

We have used PolyMem too. Skip's wound nurse swears by it. It must have done well, because we used it for a while during the final stages of Skip's healing.

You might want to look into getting a low air loss mattress on a hospital bed for your husband. Skip has been using 1 for 2 years and it is a big help. One nice part of the hospital bed is that it rises up so there's less bending over for the caregiver ... a nice backsaver.

Caregiving is the hardest thing I've ever done. I have a lot of respect for other caregivers, especially older folks who have their own aches and pains to deal with. Best wishes for you!