6 January 2022
Today we had a phone chat with Dr. Tong about where we go from here. Earlier when I did Joyce's dressing change, I sent her a photo of the wound to Dr. Tong and she liked what she saw.
The muscle has remained free of slough even if the tissue alongside it is covered with it. She asked if we thought the wound had gotten smaller and I agreed it seems to be a bit smaller. Another good sign.
The question she had for Joyce was the big one. Do we try to close the wound with Integra or do we continue as we are?
We have been discussing this since she met with us at the clinic at the end of November, of course. With Dr. Tong by phone, with the nurses here to do dressing changes, between ourselves.
The consensus is that there's no advantage to waiting to close the wound.
As it is, Dr. Tong said, the Integra solution may not work. There is only a 50 percent chance it will adhere to the tissue and permit her to close the wound with a skin graft from Joyce's other leg.
In which case we would be back to wet-to-dry dressings.
But it's worth a try, Dr. Tong said. There's nothing to lose by trying it.
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ORIGINALLY TODAY'S MEETING was scheduled as an office visit, perhaps with a debridement.
But yesterday, Joyce was on the phone several times with Kaiser to determine if it was a video call, a phone call or an office visit. And every call seemed to result in a different answer.
So this morning, about the time we would have had to leave to arrive there on time, she called the clinic to ask them what was scheduled. A phone call.
They don't want people coming in unnecessarily during the Omicron outbreak.
That same issue is why Joyce won't be going into the hospital quite yet. Dr. Tong thought it wasn't smart to expose her to Covid during the outbreak.
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BUT WHEN OMICRON DIES DOWN, she'll set a surgery date.
Joyce will go in for a surgical debridement under anesthetic. At the same time, Dr. Tong will take cultures of the slough and get an antibiotic cocktail to kill any infection.
She'll do debridements as necessary while the antibiotics clean up the infections. Then she'll apply the Integra layer.
The wound is dressed with a Wound VAC, which is recommended for up to four weeks before closing the wound. Dr. Tong knows Joyce hates the Wound VAC and was agreeable to switch to wet-to-dry dressings after a week if Joyce refuses the Wound VAC.
In any case, she would send her home as soon as possible, perhaps a few days after applying the Integra.
Given only a 50 percent chance of success to begin with, I'd like to persuade Joyce to stick with the Wound VAC, of course. There's also the risk of tearing the Integra during a dressing change. And with wet-to-dry there are more dressing changes (two a day) than with a Wound VAC (only three a week).
The hospital Wound VAC is larger and quieter than the noisy, cast-iron purse-sized, portable models they send you home with. Everyone hates them, Salwa the LVN said, because you can't escape them. You have to take them everywhere.
At least in the hospital you aren't going anywhere except up and down the hallway.
Stay tuned. The plot will shortly thicken.