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SleepingUgly wrote:

ozij wrote:

NotMuffy wrote:

DoriC wrote:Certainly, seeing the people at The Wound Center in conjunction with your surgeon could be a possibility (unless they have a preferred guy).

Update, The wound center is giving us an emergency appt tomorrow at 8:30AM. I just spoke to my son and asked his opinion about being able to see both drs and he said very frankly if it was his patient coming to him and wanting to use another dr's procedure much different then the one he's prescribing, he would be within his rights to refuse to continue with the care if he's not in agreement with the plan another Dr is recommending and the patient was not adhering to his preferred treatment plan. In fact, he could be opening himself up to liability if something goes wrong. So we're between a rock and hard place and we'll have to see what transpires tomorrow. We have many questions. My son's only concern and ours is what will happen if Mike has another abscess and our surgeon prefers not to get involved again? There's nobody else we trust to operate if it comes to that and my son is pretty sure that when the chips are down his Dad will agree to more surgery if there's no other option but only with our Dr. S.

I have some recommendations that you might want to run by your son, as it involves him. As soon as you get in to the appointment tell the doctor, "My son is a doctor and his friend, Dr. So-and-so (if the guy knows him, otherwise just say 'his doctor friend') highly recommended you..." You can mention that your son would like to call and talk to him, and ask if it's OK (of course it's OK, you're just being polite). By doing this you've now let the doctor know that two physicians (your son, and his referring doctor friend) are keeping tabs on things. Have your son call to discuss the case with the doctor.

I'm sorry that the truth is that family members of doctors often get better care (or at least no worse), but it's the truth and you should use it to Mike's advantage.

Next, I would let your son handle the issues with the turf and possible complications. While two of them working on Mike simultaneously might be impractical, or not, it's not unreasonable that if this new doc doesn't do surgery of the sort that Mike would need if he had an abscess, the other guy would (although I'm not sure why the new doc wouldn't deal with it). But let your son, THE DOCTOR (have I mentioned that enough times?) deal with this, IMO.

Edited to add: A professional mensch of a surgeon would not turn you away because you went to someone else for wound care. Could he? Yes. Should he? No. To decrease the possibility of this occurring, your son the doctor should call the first surgeon and let him know what your plans are (once you figure that out), thank him for all the care he's given, and thereby let him know there is a doctor-son involved. It would be highly embarrassing for the surgeon to tell another doctor that he won't see his father because he went to see another doctor.

I hope your son has a lot of free time on his hand, because I'd like to assign him some more tasks.

SU, I see that you have the situation down pat and what you're saying makes sense. But your last sentence is important. My son is on the go from morning to night with his practice and wanting to be with his 9mo old little princess and helping his wife. I worry about him like all mothers do and our last wish is to burden our children. We made a pact a long time ago that we would try not to involve him with our medical issues except in a casual way. He is willing to do whatever we ask of him but we feel very unhappy dragging him into this full force and it's presenting another anxious problem for us.We may have to do as you suggest and bring in our "big gun" but I hope not. We may make an appt with our Primary and see what he says, he knows Mike's medical condition, he knows the wound center and our surgeon very well.

Well, you can still say that your son the doctor's friend, the doctor, recommended the surgeon. That is true and won't take any time out of your son's busy day. (Rats, and here I was going to have him help me with some yard work this weekend...)

DoriC wrote:SU, I see that you have the situation down pat and what you're saying makes sense. But your last sentence is important. My son is on the go from morning to night with his practice and wanting to be with his 9mo old little princess and helping his wife. I worry about him like all mothers do and our last wish is to burden our children. We made a pact a long time ago that we would try not to involve him with our medical issues except in a casual way. He is willing to do whatever we ask of him but we feel very unhappy dragging him into this full force and it's presenting another anxious problem for us.We may have to do as you suggest and bring in our "big gun" but I hope not. We may make an appt with our Primary and see what he says, he knows Mike's medical condition, he knows the wound center and our surgeon very well.

While he is very busy, as a child of aging parents who is heading out of town to do what she can to help them,I say remember he is the child of this man and would probably feel guilty and hurt if he does not do something to help. It is a tricky line to walk but don't push him out of the way or protect him too much.

Black Spinner, I understand what you're saying and I'm going to have to think about what you've said. I wouldn't want him to have any regrets if that's what I'm hearing in your comment. Thanks.

DoriC wrote:I just spoke to my son and asked his opinion about being able to see both drs and he said very frankly if it was his patient coming to him and wanting to use another dr's procedure much different then the one he's prescribing, he would be within his rights to refuse to continue with the care if he's not in agreement with the plan another Dr is recommending and the patient was not adhering to his preferred treatment plan.

Care of chronic wounds encompasses a myriad of personnel and services, and certainly a labyrinth of tunneling will frequently require surgical support. However,

...seeing the people at The Wound Center in conjunction with your surgeon could be a possibility (unless they have a preferred guy).

does not mean to say that you should get multiple surgeons; rather an alternative wound care center might offer a second opinion on treatment plan (and this person could very well be a medical rather than a surgical person); a different approach to the day to day wound management (such as assorted adjuncts); effective infection control; and consideration of HBO. You absolutely have the right to choose your surgeon.

Further, aside from maggots and leeches, I can't imagine where a treatment plan would be so "different' that the surgeon would drop the case for fear of liability and legal repercussions. Indeed, after 4 months, I would think that your surgeon might welcome some fresh ideas.

But putting aside the technical aspects of wound care for a moment, what should be common to the chronic wound care patient is the consideration of their psychological care:

Patient centered: It is always wise to remember that we are dealing with a person who happens to have a chronic wound. We can develop a wonderful management plan but if we do not have patient buy-in the plan is doomed to failure.

Assess the patient’s environment and supports for managing stress and depression related to the wound. Individuals with wounds often require psychological support to adapt to and cope with the wound, and to manage stress, changes to body image, and depression.

Several recent studies report that chronic wounds pose a threat to physical functioning and have a negative impact on psychological functioning, and to a lesser degree, on social functioning. Major limitations reported in these studies were pain and immobility, followed by sleep disturbance, lack of energy, limitations in work and leisure activities, worries and frustrations, and a lack of self-esteem. Patients have a significantly poorer quality of life compared to healthy people. The specific reasons for the poor levels of health-related quality of life are multi-factorial and include: frequency and regularity of dressing changes, which affect a patient’s daily routine; a feeling of continued fatigue due to lack of adequate sleep; restricted mobility; persistent pain; wound infections; and social isolation. The requirements and consequences of having a chronic wound also have an enormous impact on the patient’s social life, as well as the lives of their caregivers. The loss of independence associated with functional decline can lead to several, sometimes subtle, changes in overall health and wellbeing. These changes include altered eating habits, depression, social isolation, and a gradual reduction in activity. The presence of these factors, along with immobility, not only influences the occurrence of further wounds but also exacerbates their severity and jeopardises their ability to heal.

From a clinical perspective, it is important to recognise these debilitating aspects of living with chronic ulceration and to develop comprehensive packages of care that focus on the needs of the patient.

http://www.woundsresearch.com/content/m ... bahons-phd

So, "IMHO" if your guy is truly a "wound care guy", I would like to believe that he understands that psychological support is as important as medical support in these cases, and will support you decisions.

Completely.

Thanks NM, I printed out your post and the article to put into my "package". Something of interest happened just a few minutes ago, quite late but not unusual for our Primary to return calls at that hour. He told me that he was glad we were going for a second opinion and was happy to have given the referral. But he was curious as to why we asked him rather than our surgeon. We were both watching our words but I did tell him the surgeon didn't object to another evaluation but was not in favor of the wound center we chose. He was careful not to give any details but he mentioned that he "thought but was not sure", that one of the surgeon's patients had a bad outcome at this particular center so that might be the reason. I don't know if it's fate stepping in to lend a hand but I swear Mike's wound looks healthier and smaller today as if it's trying to turn the corner as it's done in the past, I pray it's not my imagination. Maybe all the fuss will have been for nothing and I can apologize for taking up your time and everyone else's! Wouldn't that be great! I don't know if I forgot to mention that we've been given an emergency appointment at the Center tomorrow at 8:30AM. I'll keep you all posted. Good night.

Well, a "bad outcome" (and "not sure" of a bad outcome) can be anything. You're still in Information Gathering Mode, and if necessary, you could always research another Wound Center. Hopefully, Mike is getting better (obviously the whole point of this endeavor-- how that happens is academic).

You might be able to get a rough idea of the Wound Center's performance. Most wound centers use one of two software packages (Wound Expert or Intellicure). Each of them allows a WCC to measure it's outcomes against their national database, so you can get a good idea of how well a WCC is performing (a better method than "I'm not sure, but somebody said that a friend thought that their sister's cousin's dog read somewhere...). Anyway, ask them what Wound Software Package they use and how well they do in outcomes measurement.

Good luck this morning!

Good luck from here, Dori. I'll be watching for an update.

UPDATE!! I'm trying not to be too excited but we really got some good news today!! The Wound Care Doctor spent a lot of time with us going over the hx and explaining in his words how delicate and precise this type of surgery really is and that there is probably no one else in this area who would even attempt it and especially not multiple times. He agrees that since the shrapnel is imbedded inside the bone,this is a chronic condition, probably osteomyelits, which we already knew, which is being kept in control by not allowing the low grade infection always present inside the iliac bone to burst out into the blood stream He can think of at least 5 other scenarios that would be worse than our present situation and he named a few. He agrees with Dr S that the tried and true wet-to-dry packing method is the way to go in this case, but 1x daily is enough. He was very impressed with the cleanliness of the wound bed. He's not concerned about the length of time it's taking to heal, we have no control over that but he thinks that with this method it will heal but when and for how long before it abcesses again,nobody has that answer. He complimented me on my expertise of the wound care itself and acknowledged that some of my concerns were valid by having the wound expert RN give me some very helpful tips to address them. When Mike asked if there wasn't anything else that might help speed things up, the Dr jokingly said he could give him a "tushectomy". His last words to us were that Dr S is a very fine and intelligent surgeon and after performing such delicate surgery he wasn't about to lose the case to poor aftercare. This has lifted a great weight off us and satisfied our doubts. We're now going to look at this as part of our daily routine for as long as it takes and not as having a "sick person" living here. Mike drove home from the office, the first time in 4 months! You'll never know how much good you've done by allowing me to describe our situation in such detail and vent my despair. I send my blessings and thanks to all of you.

This is great news indeed.

WAHOO!

This sounds like really good news...and you sound so much better. I'm really glad.

Keep the board posted, k? We're all concerned for you two and want to keep up with how it's going.

Thank you, NM for encouraging her to go. It sounds as though it as worth every effort, just to know that she had been doing the right thing all along!

Dori, don't ever think that you have wasted anybody's time. We care about you and Mike as though you were family.

Bev