Slow Healing Wound

by DoriC on Sat Apr 30, 2011 5:39 pm

NotMuffy wrote:
DoriC wrote:
Mike's wound has still not healed(almost 4months and still 2" deep).
I think the first thing that one needs to determine in order to plan a course of wound care is what exactly the nature of the wound is. If the wound is caused by insufficent circulation, for example, unless the blood supply to the area is improved (surgical intervention), then it is unlikely that any of the wound care approaches will stand much chance of success. And I'm kinda thinkin' that if you've been attacking this thing for 4 months with an aggressive wound care team you've got an underlying arterial problem. Can you post your ABIs (what medical discipline doesn't have a heap o' acronyms?)?
http://findarticles.com/p/articles/mi_q ... in;content
Not Muffy, Thanks for your interest, I really appreciate it. So as not to hijack Madalot's thread any more than I have already, I'll try to start my own thread on this and hopefully give you a better picture.

Gee, I think I did it! Not Muffy, I hope you'll follow me here. Mike's wound is in his buttock where mortar shells entered during the war. He had extensive surgery but shrapnel was imbedded into his iliac bone and left undisturbed all these years until he had hip replacement about 10yrs ago. He's had 5 acute abscesses since then requiring surgery about 5" deep to the bone. The shrapnel itself is inside the hipbone surrounded by bacteria but cannot be removed without losing his leg. IV Antibiotics can't get to it. In the past it's taken 2-3months to heal but that's because the top closes while the bottom has not healed completely. This time the Dr keeps stretching the opening with an instrument 2x/wk to keep it open to allow for packing until the bottom heals. That's where we stand right now. I'll quote the Dr's response to my concerns as of Friday. I wrote it down. "There is adequate blood supply, evidence of new tissue growth, wound bed is beefy red w/granulation,no sign of infection or necrosis,but because of previous surgeries there is tunneling in different directions which is hard to heal". Thanks for any thoughts you have.

OK, so much for the ABIs.

Boy that does sound like a pesky problem. Has/is your team using any of the medicated packings?

I have another question.

Does your facility have HBO on site if they did choose to go that route?

No medicated packing, just plain sterile 1/2" packing with saline and 4x4 sterile gauze pads.I asked about medicated packing once and Dr just shook his head and said "not in this case". I also asked our VN(who has an advanced degree in wound care) and knows our case well. She said in her experience some Drs use it with success on certain wounds and she's seen failures as well. She wouldn't venture an opinion in our case and I couldn't get a good "read" on it from her. But I only raised that question briefly at the beginning and never really got a satisfactory answer from the Dr, so I'll bring it up again. It's on my list. As for HBO, that's the other problem besides the medical issues I mentioned, we'd have to go to NY or PA, we live in Central NJ, so either place is 2-3hrs by car to a congested area,which would be a tremendous hardship physically and emotionally for us at this point. You've raised some good questions that have kind of gone by the wayside along the way but which I'll resurrect again. Maybe I'll get some different answers now that the team seems to be getting a bit discouraged. I know we are. I have the feeling that they're all being extra cautious with Mike's treatment because of his age and medical history of CAD, 2 Triple Bypasses, Aortic Valve Replacement and it's apparent he's also getting quite fragile at this point. BTW, the only good news here is that his cpap therapy is going better now after a few setbacks. He's my hero! NM,Thanks for staying with me on this, it means a lot.

DoriC wrote:As for HBO, that's the other problem besides the medical issues I mentioned, we'd have to go to NY or PA..

Y'know, I suspected as much. They won't use it cause they ain't got it. More than 30 days of failure to respond, pesky tunnels, probably some osteo, and there's the poster boy for HBO. Certainly fear of losing the patient could be a factor.

BTW, there's only one absolute contraindication for HBO-- untreated pneumothorax. And if you put a chest tube in, those people can go in too (there's also a short list of drugs, but they're weird things, like chemo drugs). Dives can be made cautiously based on the patient.

"TS", maybe he is a risk, and if so, fine. Unfortunately, Muffy is a cynic at heart.

How close are you to Overlook in Summit?

DoriC wrote:No medicated packing, just plain sterile 1/2" packing with saline and 4x4 sterile gauze pads.I asked about medicated packing once and Dr just shook his head and said "not in this case". I also asked our VN(who has an advanced degree in wound care) and knows our case well. She said in her experience some Drs use it with success on certain wounds and she's seen failures as well.

In that respect, wound care is kinda like CPAP masks. Sometimes they do, and sometimes they ain't.

http://www.polymem.com/CaseStudies/MKL3 ... line_id=26

http://hwca-inc.com/Providers/CaseRepor ... minal2.pdf

BTW, that guy Jeffrey A. Niezgoda, MD is a major player in wound.

DoriC wrote:... the only good news here is that his cpap therapy is going better now after a few setbacks.

I wonder how these guys made out:

http://clinicaltrials.gov/ct2/show/study/NCT00679757

It's funny you bring that up! I think that's one of the reasons our Drs are so disappointed in the slow healing process this time around because the first thing they said when he presented with an abscess on Jan 7th is that we should be seeing faster healing after surgery now that he's been diagnosed and successfully treated with cpap therapy and better oxygen levels. I would think so too.

Dori, I've been following Mike's and your saga. It's hard for people not familiar with all the details to figure out what may be a good idea for Mike. But I think NM's thoughts about medicated packing and hyperbaric oxygen are important considerations.

I understand travel to reach HBO may be difficult or impossible. I googled "New Jersey hyperbaric," and found a number of HBO facilities in your state. Maybe one of them will be closer to you.

Possible, medicated packing won't work, but I wonder what the reason is for not trying it.

I don't remember what specialty your son is in, but has he had any thoughts about these two untried treatments?

Hi M.D, thanks for posting. My son is a Western-trained Internist with solid skills in his field but his practice leans more towards holistic healing and Eastern philosophy. He hasn't been second-guessing the Dr on his wound healing methods and admits he's not up to date on all the latest stuff but he's very aware of HBO. During his training days he drew up his own rough plans for a type of HBO chamber before it was really talked about in those days. I don't remember the outcome. He realizes full well the fragile state his Dad is in and agrees with the Dr that even without his shaky medical status, the stress of the logistics of such a plan for HBO would probably do him in. He's already talking about not wanting any "heroic" measures taken about anything. He's already balking about seeing the Urologist Tues, doesn't want any invasive testing. The Drs feel the problems he's now having in that dept may be hindering the healing. But he still loves his cpap! I know medicated packing was used after one of his surgeries but was discontinued and frankly right now I can't remember why. I will definitely bring it up again this week. Tonight I was barely able to get the packing in, the top really wants to close, so I may have to make a Sunday emergency call if I can't pack it tomorrow. I'm sure we're at a crossroads right now with not too many options that I can see except more surgery which will present a big decision for Mike to make, but this discussion has given me the will to at least shake things up a bit. Thanks NM and you too M.D. and all the kind words written by everyone.

OK, just a couple comments about HBO Chambers if you decide to go that route.

There are 2 types of chambers, the big, walk-in multiplace chambers, and the single, roll-in-on-a-stretcher monoplace chambers (which are fine. The acrylic tube allows tremendous visibility, so it's not like you're in a dark tunnel).

A treatment course is typically a 2-hour "dive", 5 days a week for a month (a total of 20 treatments).

NotMuffy wrote:OK, just a couple comments about HBO Chambers if you decide to go that route.

A treatment course is typically a 2-hour "dive", 5 days a week for a month (a total of 20 treatments).

My son just called me and explained that exact treatment plan to me. He will speak to Mike's Internist and Cardiologist who've been treating him for many years to get their assessment of the idea. The surgeon says no but my son says surgeons come from a different place in the atmosphere. He also doesn't have the complete medical history or what it all means in relation to HBO. If we get positive feedback then we have to figure out a plan for doing this and if Mike will even agree to it. It would mean living somewhere else, probably NYC, for a month or more. Don't know if that's even possible. In the meantime my son will also discuss some other courses of wound treatment that may help. He agrees that the increasing incontinence(which I was not fully aware of until the last week) will have to be addressed quickly as that may be what's interfering with the wound bed. We're seeing the specialist Tues. So a lot to consider and I'm very tired and sleepless right now. NM, can you come and take care of us?? I'm only half kidding!

DoriC wrote:He's my hero!

Dori,
I've been following your story for a few weeks now, but have not commented previously. While Mike may indeed be your hero, it sounds to me like you're a hero, too! I am in awe of the way you care for him and your clear devotion to him. You are a shining example in my book! May God bless you both.
Joe

Thanks Joe, a few tears are good! Just so you know, my husband has had me on a pedestal all these years and there's nothing in the world he wouldn't do to help or make me happy. A better man you couldn't find. All I'm doing now is giving back for all the good years he's given me. In another 20 years we'll be all even!

Dori, you and Mike are such role models for me. I wish it could be easier for you. Thank you for all you contribute to this forum.