4 November 2021
This afternoon Alysse the Physician's Assistant called. She had been in touch with Dr. Tong who saw yesterday's photo of the wound. And Dr. Tong wants to do a debridement herself in the hospital as soon as possible, which would be Friday, Nov. 12.
Joyce will stay in the hospital a few days for pain management and perhaps a CT scan, returning home early the next week. And she'll come home with the Wound VAC.
But until Nov. 12, we'll return to wet-to-dry dressings to keep the wound open. But there's a twist. We'll be applying Santyl, an ointment that "debrides by cleaving necrotic tissue at seven specific sites along the denatured collagen molecule, unlike endogenous debridement that only works at one site."
That's better than using Dakin's Solution and Vashe. And even better, we can't use them in combination since they deactivate the Santyl, Alysse said.
She put the order in for pickup and the pharmacy just called to say they don't have it in stock so it has to be ordered. We won't get it until tomorrow at the earliest. For $47.
I just did inventory and we do have nearly enough supplies to do two wet-to-dry dressing changes a day for seven days. I called the clinic to make sure we can get a Durable Medical Equipment order for the supplies if we need to order any from Byram but I only got the message machine.
Plan B is to get any supplies we need from our home health nurses, one of whom should be coming tomorrow.
To summarize, because the yellow slough is growing too fast for the clinic to manage and inhibits wound closure despite the VAC, Joyce will return to the hospital for a deeper debridement before going back on the VAC. Meanwhile we'll return to mechanical debridement with Santyl doing a chemical debridement as well.
In short, it's a combination of the two approaches with a bit more aggressive wet-to-dry than we've done previously.
And we can return the Wound VAC tomorrow, saving $16 a day. Apria called this morning to see if Joyce wanted to settle the bill of $490 for the first month. "Send me the bill," I said. Politely.