23 December 2021
Sorry to leave you hanging on the edge about those supplies. These crises seem to stretch out beyond any firm conclusion.
On that Friday, two days after I described our dire situation, Kevin the RN called from the office to confirm what supplies we needed. I told him about the pads, of course, and a few other things it would be nice to get without paying or dealing with Byram.
He showed up a little later like Santa Claus with a case of 6x6 pads, 100 of them. So, using four each time, or eight a day, we knew we could get to Monday's delivery of the 8x9 pads from Byram. And he brought a tube of that expensive Santyl.
Good man. Miracle worker.
But on the same day, Byram pushed the shipping date back another day. Which meant Saturday not Friday. Which still seemed to promise Monday.
Late Monday a partial shipment of the 8x9 pads arrived. So we've been using one of them to cover the lower part of the wound with two of the 6x6 pads on top.
Today, the rest of the order arrived. But, you know, I think we'll just keep stretching these out a bit with the 6x6s. Maybe in January we can wrap this all up.
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THIS WEDNESDAY we did go to the clinic for a minor debridement with Cat. I had sent Dr. Tong three questions by email in preparation and Cat addressed them when she came back out with Joyce.
She promised to call Byram about our supplies again. That was one issue.
In answer to my second question, she said to continue the Santyl with a dry dressing or use a wet-to-dry without it. It doesn't seem to matter what we do, the yellow slough grows over the wound anyway.
And she told us to make an appointment at the clinic with Dr. Tong for Jan. 6 to discuss where we go from here.
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BECAUSE THE THIRD QUESTION I asked her got the answer that they were looking into it.
And that was whether Dr. Tong thought the use of medical maggots might be appropriate in a wound as reluctant to heal as this one.
I had been listening to NPR when I drove to the mall to shop for Joyce's birthday present when I heard an interesting presentation about the maggots. Before penicillin (you know, like around the Civil War), they were used to debride wounds.
But the NPR report said they were making a comeback for wounds that take forever to heal.
A Nursing Times article explains:
Wound debridement is the best understood aspect of maggot therapy. It is now known that maggots produce a combination of proteolytic and other digestive enzymes that are released externally in their secretions and get distributed over the wound as the maggot crawls around (Thomas et al 2002). Maggot movement over the surface tissue facilitates the penetration of these enzymes into the necrotic tissue, causing it to break down and liquefy into a nutrient-rich fluid that the larvae subsequently ingest. Two key enzymes, trypsin and chymotrypsin, have been identified as being produced by medicinal maggots (Chambers et al 2003), with studies suggesting that key to their effectiveness is the ability of these enzymes to withstand endogenous wound inhibitors that would normally degrade and destroy other enzymes (Telford et al 2011).
As I understood it, the maggots are contained in a pouch that is applied directly to the wound. They excrete their enzymes, liquifying the dead tissue only (the yellow slough) and suck it back up through the fabric pad. After a few days, the pad is replaced.
Wounds that have not healed in a year, show a year's worth of improvement in a few days, the NPR report noted.
Given that at our last meeting with Dr. Tong she expressed her concern that the wound was not healing and could not remain open indefinitely, I thought it worth asking what she thought of this approach.
Cat assured us that Dr. Tong is very data-driven and fact-based. She hadn't talked to her in a week, but she was confident she'd look into it and report back.
Meanwhile Salwa the LVN was interested in the therapy so we sent her the link. She tried to find out if it had ever been done at Kaiser but couldn't get an answer.
I think of it as a long shot. But isn't that what Steph Curry is famous for?