Friday, October 31, 2008

The Wound Specialist

This morning I had an appointment at the wound clinic out of the Elliot Hospital. I had to be there at 7:30 - getting up and ready to go made it so that I had to actually get up at 6:00. The hospital is maybe a 15 minute ride from my house, but to be out the door on time made it so I had to get up twice as early as I normally would. I got a shower before going to bed last night - thank goodness for the shower chair - and it made getting ready this morning that much easier.

Martha and I went in separate cars - after all, it makes sense, considering the building she works in is about 100 feet away from the entrance to the hospital's Emergency Department. When we arrived (she got there before I did as she took the super-secret route to the hospital where I went the way I normally do and got stuck in traffic) I checked in - that was almost unnecessarily painful because I'm already in the hospital's system. They needed a photo ID plus I had to sign an armload of consent forms. That's actually pretty standard, but the wound clinic itself has a special consent form they require their patients to sign in addition to the standard forms.

The nurse who did the initial assessment was really good. She knew what she was doing and, more importantly, put me at ease right away. She and the nursing assistant that was working with her did some interesting things, with respect to their assessment. One of the things that they did was to perform what is known as an ABI assessment - basically, it involves getting normal blood pressures in the upper extremities (they checked both) and getting a systolic pressure in the lower extremities. They only checked the right - if they were to also check the left they could possibly have damaged the surgical repair to the tendon. The actual ABI assessment is a ratio taken by dividing the systolic blood pressure in the leg by the systolic blood pressure in the arm. If the ratio is greater than 1, they can determine whether or not there is compromise to the circulation in the lower extremity area. Mine was 1.4 - no problem there.

They also took digital photos of the wound. I wanted to get them to allow me to copy it onto an SD card, but they wouldn't do it.... I did look at it, and from the angle of the camera it looks pretty nasty.

The doc did his thing after the nurse was done. Ron Zinno, MD - he's the wound guy. I'd seen him around the hospital, and from what others have told me he had a reputation for being really short with people and generally just an unfriendly individual. That may be so in their case, but what I saw is a physician who works extremely hard for his patients. He just plainly didn't stop - I think while I was there he saw 4 other patients besides myself. And he wasn't unfriendly with me. He was cordial, but I suspect it's because he is an incredibly busy doctor.

His take on my wound is that he isn't sure of the depth of it; it is not a "boggy" wound, one where there would be free fluid in the area of the wound itself. It is actually pretty solid, and there was a decent amount of bleeding caused by the pressure and friction from the cast. I need to be followed closely, especially over the next 2 weeks (I have two visits scheduled this coming week, and I wouldn't be surprised if there are more the week after that) so he can figure out how to ultimately deal with it. He opted to not debride the wound, mainly because it is closed, at least for now. I got prescribed this anti-microbrial cream that has silver (you know, the element Ag of Periodic Table fame) and some other stuff that gives it the ability to penetrate closed skin, and we're putting it on the wound and covering it with a foam-covered 3X3" bandage. I have to continue to keep weight off of it because, in addition to the tendon, I now have to worry about pressure on the site. And I need to keep it elevated because, in addition to this, they discovered that I have some pitting edema around my ankle, and it isn't going anywhere. But it is localized to the left foot and not the right, and is just above the area of the sore.

This whole experience is becoming more complex as it goes on. I am continuously frustrated because ultimately this is setting my healing time back further. And there is nothing I can do about it.

So two more appointments next week, then an appointment with the surgeon on November 18th. Plus I got hold of my therapist and I am seeing him this coming Wednesday.

And I'm having more fun than any human being should be allowed to.....

3 comments:

MedicThree said...

ooooh.... sounds like fun...

Did they give you Silver sulfadiazine(Silvadene and Flamazine)? I had a couple real bad burns that they gave me that.


hit me up with an email to medicthree@gmail.com and we will sort out our options for getting the domain name registered.

Walt Trachim said...

Yup - Silvadene, that's the stuff.

I'll drop you an email over the weekend. Thanks!!

Cheating Death said...

Silvadene is good stuff. I had to use it after a small motorcycle accident. My uncle was a fueler for a F1 team and had a gas leak down is neck and had to use that(before they would do grafts) for a while. It was like magic for me....