15 March 2022
We left the house at 9 a.m. for Joyce's 10 a.m. appointment with Dr. Tong. The Kaiser computers were down when we got there but before we could be called in, they miraculous came to life again and Joyce had to pony up a $15 copay.
This time Dr. Tong invited me into the exam room. And, to my surprise, she also replaces the Wound VAC dressing. That's something that has never happened in the clinic. So I thanked her. Which amused her.
She's not bad at it (I'm a connoisseur of Wound VAC practitioners). She's easily the league best at cutting the black foam. And she replaced the dressing faster than anyone else has. But she did have a little trouble with the tegaderm drape. Understandable since Joyce was lying on her side instead of her stomach.
She didn't frame the wound in tegaderm either, which is one reason her replacement was so fast. And she didn't diddle daddle with the bridge. She got the tegaderm down, put the foam bridge over it (after ripping the end off by hand) and covered it with tegaderm. Impressive.
But that was all after she evaluated the wound. She liked what she saw around the muscle and the situation in general was better than when Joyce was last admitted to the hospital.
But the yellow slough had taken over the upper portion of the wound again and has to be removed surgically. At the same time she'll do a culture. And if the culture shows infection, Joyce may need a midline antibiotic course again. But we won't know about that until next week when the lab has analyzed the cultures.
"The wound can't do anything for itself," she explained. "It's like a baby. We have to protect it."
So I'm expecting these monthly hospital debridements and cultures as we continue with the hyperbaric therapy.
"When does the hyperbaric therapy end?" Dr. Tong asked me.
"Well, they tell me a full course is 60 sessions, so that's three months."
She's hoping to get the wound pink enough to get the Integra on and hoping that attaches so she can close the wound with a skin graft, as you know.
She doesn't want to risk a skin flap with the 10-hour operation rerouting blood flow to her foot because Joyce is ambulatory now. The Integra may fail, but it's not a risk to her ability to walk.
So Friday Joyce will have an hyperbaric treatment at 8:30 in the morning (already scheduled with Kathy the LVN) before going to Kaiser for add-on surgery in the afternoon (at the earliest). She'll be kept overnight and resume the hyperbaric treatments on Monday.
At this point, we aren't skipping a beat.