A New Home for an M Series Auto w/Cflex?

Our cup runneth over! We have recently been given the opportunity to purchase a gently used S9 Autoset and PRSystemOnePro. We now we have our original M Series Auto w/Aflex which we'll keep so we are interested in selling our backup M Series Auto w/Cflex w/Humidifier in excellent condition with very low blower hours for a reasonable price. I even have some extra goodies that I'll include. PM me if interested.

Bump, in case anyone missed this. Thanks.

Speaking of backup M Series Auto w/Cflex w/Humidifier in excellent condition, how's wound/osteo progress coming?

deltadave wrote:Speaking of backup M Series Auto w/Cflex w/Humidifier in excellent condition, how's wound/osteo progress coming?

Yeh, I can see how you would connect the two!!

I've been putting off on an update because I haven't convinced myself yet that it's really working although his measurements went from 3.0cms deep(the same for 6months) 15 treatments ago to 1.6cms. (Our RN measured 1.0?). She discharged him Friday but we have mixed feelings about not seeing her anymore. There is absolutely no more drainage, the wound bed is perfectly clean,no more packing, just clean and bandage. Medicare originally approved 20 treatments but has now approved 10 more so we're now half-way to 30 total. There was an ongoing debate among several Drs about antibiotic treatment at this time, the wound Dr prescribed Keflex which he took for one day until our surgeon called me at 8AM the next morning and told me to stop! His rationale along with Infectious Disease Drs was that since he has no active infection, everything is clean and healing, cultures neg,etc, it would be"against good standard of care". He said antibiotics are over-prescribed and too many people are dying since there are no defenses should a superbug come along later on. I'm just paraphrasing as there have been many long discussions. My son put his 2cents in on this and agrees and would not prescribe antibiotics now. Our only ongoing problem now is this big ball of wax in his "good" ear(he's deaf in the other)that they can't seem to remove. We saw an ENT Friday who couldn't remove it either so we have to do treatments until Wed and see him again. He doesn't like Debrox which I was told to use, says it just hardens the wax, and wants us to use warm baby oil 3x/day until we see him again. Thankfully, the ear drum is OK but they're a bit concerned. Are you glad you asked? PS: Don't know if it's coincidence or not, but he's sleeping much better and data agrees.

DoriC wrote:Are you glad you asked?

Absolutely, and thanks for the update!

If Medicare authorized another bullet, then at least somebody documented improvement.

Has the surface area of the wound decreased?

Yes, the surface area has decreased so much that it's almost closed and can hardly be measured,and can't be packed any longer, but that's always been the problem, the top closes before the bottom heals up. This time, a first, the bottom is almost healed up to the surface at the same time, just about 1/2"more to go which they're confident will close up nicely with HBOT and without residual infection. Yes, the nurse told me he was "recertified" by Medicare for 10 more treatments within the hour because they could show marked improvement and he would benefit from additional treatments. I don't know if I'm reading my own interpretation but I notice you've not commented on the antibiotic debate, so is that because you disagree and don't want to "stir the pot"? Or do you understand the reasoning behind the decision? Dave, I really appreciate the time and support you've given me, I always learn something from you.

DoriC wrote:I don't know if I'm reading my own interpretation but I notice you've not commented on the antibiotic debate, so is that because you disagree and don't want to "stir the pot"? Or do you understand the reasoning behind the decision?

Stir the pot?

Moi?

As noted in the other thread:

deltadave wrote:Anyway, HBO in osteomyelitis is not simply "let's drive a whole bunch of oxygen in there"-- rather, it is proposed that

• HBO enhances oxygen-dependent leukocyte killing through the production of hydrogen peroxide and superoxide by providing increased oxygen tension in the hypoxic tissue;
• Optimal tissue oxygen tension enhances osteogenesis and neovascularization to fill the dead space with new bone and soft tissues;
• HBO has also been shown to enhance osteoaclastic activity to remove bony debris;
• Synergistic effects of HBO on bone healing with bone morphogenic protein (BMP) were demonstrated; and
• HBO has been shown to potentiate the antimicrobial effects of aminoglycosides, and possibly sulpha drugs and vancomycin, in the killing of susceptible bacteria.

The role and effectiveness of adjunctive hyperbaric oxygen therapy in the management of musculoskeletal disorders.

In regards to the last activity, it is important to note "susceptible" bacteria. ABX Therapy needs to be culture-based.

If they're saying that there's no infection now, the strong implication is that there wasn't infection 16 HBOTs ago, and consequently there was no "chronic refractory osteomyelitis", which it would have to be in order to qualify for HBO:

dd wrote:Is the intent of the HBO salvo to address bone involvement (osteomyelitis) or the wound itself?

DoriC wrote:Dave, after seeing your post I asked that very question separately of both the Doctor and Nurse/Director of the program and they both said this treatment is aimed at both wound healing and the underlying osteomyelitis to prevent recurrence.

"Preventing recurrence" sounds like dancing 'round the HBO indication. So perhaps the question to ask today is "Does Mike currently have 'chronic refractory osteomyelitis'?"

If the answer is "yes", then say "Great. What bug do you suspect he has?"

If the answer is "no", then the osteo doesn't qualify for HBO, and we simply plod on with wound repair.

DoriC wrote:(you) don't want to "stir the pot"?

Ask for copies of all the documentation to Medicare. Tell them you've been getting advice from a CPAP forum. Right after you finish saying "forum", take a picture of their expression.

That said, if the wound completely heals, the end justifies the means and the discussion is academic.

And you have to admit, your machine ad is getting a lot of exposure.

deltadave wrote:

DoriC wrote:(you) don't want to "stir the pot"?

Ask for copies of all the documentation to Medicare. Tell them you've been getting advice from a CPAP forum. Right after you finish saying "forum", take a picture of their expression.

That said, if the wound completely heals, the end justifies the means and the discussion is academic.

I would like to see the documentation too and what dx they used for Medicare and why was it so easy to get an additional 10 treatments? I'm not hearing too much this time about "chronic refractory osteomyelitis", although that's what they told me after his past surgeries. All his cultures from within the wound this time came back with plain old Staph Aur with just some colonized MRSA on the outside layer of skin but not inside. The Infectious Disease Dr was happy that he had a choice of many ABX to choose from and only 5 days IV and 2 weeks oral at home. In the past some surgeries showed cultures with some unusual hard to treat bacteria (can't remember)which took a longer hospitalization with ABX . I'm beginning to think they're not sure themselves this time. I asked the question again to an Orth surgeon who also knows Mike's case well and knows my son from Mt Sinai (he came and sat with me in the cafeteria the other day!) about the possibility of removing the shrapnel from inside the bone and he quickly said we'd be in a "world of hurt" if a surgeon was even willing to attempt it, he doesn't know of anyone who would. I was surprised that he was privately keeping up with our case and will speak to our son. We saw our regular surgeon yesterday who was quite pleasantly surprised at the healing that's taking place. He hasn't seen it in over a week. He was all prepared to "roto-rooter" it again but did nothing except clean the surface with some saline and bandage. I think he's cautiously optimistic as am I. I hope you are too! Hey, do you want to buy a nice M Series Auto??