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Sorry. Mom again.

MaggieD

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Looking for some input.

Mom's bruise turned into a nightmare as some of you have read. I'm not convinced she's gotten good care . . . I think when the doctor first saw the bruise three days after it happened, she should have been sent to a surgeon immediately. And, most importantly, she should have been told to stop taking her baby aspirin a day. (The surgeon we saw Wednesday said that was part of the problem.) At any rate, here we are.

The surgeon numbed up her leg and cut off an area of dead skin probably five inches long by one-and-a-half inches high. Then he gently removed the clotted blood back as far under the skin as he could and left the crater. It's probably about a half-inch-plus deep. It has to be packed and re-wrapped twice a day. It drains like crazy, right through gauze pad packing, gauze wrap and the Ace bandage. (I know this is disgusting.) It hardly hurts mom at all except when I'm packing it.

I honestly feel like I'm in a horror movie. The doctor okayed visiting nurse services on Wednesday; however, I haven't heard from one.** I am scared to death it's going to get infected. He also made it clear that he's going to have to remove a lot more skin that's necrosed due to the lack of blood flow caused by the hematoma. And skin grafts are in her future.

She's supposed to see the surgeon next Wednesday for follow-up care. But I just realized that the appointment they made for her is with another surgeon on the team...not the one who initially evaluated her. Because mom moved in with me four months ago, her doctors are 45 minutes away. That hasn't been a problem. Now it is.

My questions are these: Should I try to find a surgeon 20 minutes away (another hospital) for follow-up care? Would mom be better off in a nursing home/rehabilitation facility during this time? Would you call the doctor today (their practice is closed) and have him either follow up with home healthcare or give me their contact information so I can get a nurse out here? Should I take her to the emergency room at the 20-minute-away hospital and get social services involved there for home healthcare?

This kind of home care seems above and beyond what a layperson should be doing. It's not hard to imagine that she will lose part of her leg if this doesn't go right.

Do you have any suggestions?

**Yeah, I know it's Thanksgiving; but I don't give a damn. I was a Realtor, and I hardly got any time off at all. I took calls on Christmas Day, for God's sake. You choose the profession? It goes with the territory. Sick people don't give a damn if it's a holiday weekend. They just keep getting sicker sometimes.
 
Couple of questions. Is she diabetic? Where on her leg is the wound located?
 

So sorry about your mom's health issues Maggie. I'm no doctor, so I wouldn't really know what to do, but if it looks really terrible, maybe you should just bring her to the nearest emergency room and insist that she be admitted for proper care.

It sounds like it's an infection, but if that's the case, I can't imagine why the doctor wouldn't have her admitted to the hospital for some intravenous antibiotics.
 
lizzie said:
Couple of questions. Is she diabetic? Where on her leg is the wound located?
Click to expand...

Hopefully she isn't a diabetic. Again, I can't imagine why the doctor wouldn't admit her for IV antibiotics.
 
lizzie said:
Couple of questions. Is she diabetic? Where on her leg is the wound located?
Click to expand...

No, she's not. It's between her knee and her ankle in the shin area. The only thing I'd say about the condition of her skin is that she's had very swollen legs for years. That all ended four months ago when she came to live here, and I controlled her food and salt intake. She went off of all her diuretic meds except one. And interestingly can eat just about like we do with no more water retention.
 

That's good news, because wounds in diabetics usually get badly infected and do end up in amputation a lot of times, especially in older more feeble people.
 
I have not been following along but...depending on why your Mother is on baby asprin it might be a significant risk to stop it, if she has Afib they have to bridge her if they want to preform a procedrue due to the risk of stopping it, coumadin might be significant though. By the time the bruise was visible it is quite possible it was no longer bleeding and stopping the ASA would have just caused potential harm and no benefit. Generally IV antibiotics would be required for bone infections but usually (but sometimes) not for soft tissue. Infection is always a risk, but I assume she is on PO antibiotics and with reasonable care and BID dressing changes it should heal. It sounds as if she is getting good care and see no reason for a change. I really dont like the ace wrap on her leg though, is she ambulatory?
 

She's ambulatory from the bed to her transport chair to the bathroom...and occasionally the 15 feet to the front door and back to look out the window. She's VERY unsteady on her feet. Balance issues more than anything I'd guess. Funny you mention the ace bandage. I hate putting it on. For a layperson, what's too tight??
 
I agree about the risk of infection, unless te wound is being packed with an antibiotic preparation.

From what you describe, I recommend a trip to an emergency room in a different hospital are area. Tell them what you've told us, including your fear and deep concern. It seems incorrect to me to have you dressing such a serious wound at home, especially with an elderly patient.
 
You can handle this Maggie. Honestly she will end up getting better care from you than in a nursing g home. How many times a day are you changing her packing?It seems you are doing it often enough to be aware of any infection. What you are seeing now is the results of the hematoma. As bad as it looks (and it is going to look worse) she is on the right track. Now that the pressure is off of it the doctors are waiting for the rest of the dead tissue to identify so it can be removed, only then can they close it. The edges of the wound are going to dry and turn whitish and the surgeon will remove it. What you are looking for is hard red skin around it or a yellowish white discharge from the wound. If you see that take her to the ER so the infection can be treated early. Open wounds like that are ugly but not particularly painful.

One thing you should be doing is taking a picture of it every time you unwrap it. You don't need to change doctors, just get contact info for whoever is the primary so you can send them time stamped pics if you see progression. The more accurate the information they get the better. Keep in mind most people will overstate the severity of a wound and doctors are aware of that. Time stamped photos eliminate the question of judgement.
 
If you are just using it to hold the dressing in place dont make it anytighter than you have to for that purpose. Just dont get ti too tight. It does sound like you are doing a fine job. Oh yea, it is many times more likely she would contract an infection in a hospital or LTC facility than at your place.
 

Does she have a chronic reddened discoloration of both legs below the knee? Any history of venous insufficiency that you are aware of? I really woulnt be overly concerned about her losing the leg unless she has some circulatory issues which impded micro circulation and wound healing. It sounds like the tissue slough was on top of the hematoma. As for infection, watch for a change in the characteristics of the drainage (change in color or a foul odor, primarily).
I would probably find a surgeon in your area to manage this. Without my knowing details of her medical history, I am just taking guesses.
 

I'm thinking that IS what it's for. That's excellent advice I can understand. And thank you for putting LTC facility into perspective. I appreciate that -- makes me feel better.


While the nurse was visiting a couple of months ago, I mentioned that both of her legs are 'dark' in the back . . . almost like a light suntan . . . complete with almost a perfect line of demarcation where it ends. She said that was an indication of some poor circulation. I know the surgeon took her foot pulse and said it was strong...

I think I'm going to take your advice about another surgeon. I've gone to one. I'm going to see if he can take her. I liked him and his nurse practitioner a lot; I had home healthcare myself through that local hospital and was very pleased.

Thanks to you both - and others who've weighed in here. This **** is a bit, shall we say, out of my wheelhouse? Thank you for the encouragement. Sometimes that's all we need.

*hugs*
 

I hope it didn't sound like was making any type of judgement on the surgeon, as he is likely just as good as others- I was just thinking that finding someone closer to you would be more convenient. As for home care, if I were you, I would look for a company who has a wound care nurse, or enterostomal therapist who can come and take a look. Nurses who have enterostomal therapy certifications are typically excellent with vascular-related wounds, and can give you a better assessment of the situation as a rule.
 

Good morning Maggie and Happy Thanksgiving to you and your family.

I'm no doctor, as I've said before, but I've been through a lot of this stuff.

1. I wouldn't be too concerned about "bruising". As people get older, their veins thin out and any movement can cause a bruise. My mother's arms and legs used to often look like she played football on weekends but it was nothing to worry about. Likewise, when she was giving blood for testing or getting poked for an IV drip, the nurses had a hell of a time finding a vein and they always apologized because her hand or arm ended up looking awful from the bruising. It's probably just a fact of getting older.

2. As for the tensor bandage on the leg, blood and oxygen circulation to the extremities is always a big issue with the elderly - it's why they often complain about cold feet, etc. - I had a nurse one time tell me never to put tight socks or tensor bandages on my mom's legs because of this. The bandage should only be wrapped sufficently to keep the underlying dressing in place, nothing more. The wound also needs air to heal so anything too wrapped or too tight is going to defeat some of the purpose.

3. At one point, my mom developed bed sores that were dangerous and severe. One on her coxis got very large and deep, to the bone, and was an oozing mess. I was fortunate and had a visiting nurse come in ever day for 13 months treating this wound and a couple she had on her legs. I would help, but you need the medical eyes on it too to ensure it's healing properly and nothing strange is happening. The nurse told me she didn't think it would ever heal but it did and she was amazed - she said it was because my mom was well taken care of and had a good appetite, things that made the body's natural healing powers work. Try as hard as you can to get the medical care in to treat this wound - as much access as you can force - and you will need to be forceful - polite, but forceful. My final comment on this one is to keep on it with this type of wound - it needs daily attention and it can go bad fast if left unattended - but don't let it scare you either.

4. Personally, I would never have put my mom in a nursing home - that's kind of false advertising, in my view - they aren't a home and there's very little "nursing" about them. My mom's personal care worker used to work in a nursing home and she had to leave because it affected her so much. She was a saint with my mom so I can see how lack of care in a nursing home would affect her. Unless you've got lots of money to get the very best of care or to hire your own nursing help 24/7 you and your mom will both be better off in your home, if you can physically and emotionally handle it. Rehabilitation centres are a different story - their job is to get you well and out the door and back home so she'd get better care there.

Those are my thoughts, for what it's worth. I'll keep you in my thoughts and prayers and hope things improve.
 
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MaggieD said:
Looking for some input......
Do you have any suggestions?
Click to expand...

Gee. I wish I could help. But I am not in medcin and the people I know do something and would, are all over here. But what you describe does sound as though your mother should be in a hospital. I described, what you had written to a doctor freind here and he said he would need to see it, but necrosis is not something he would wait till Wednesday to operate.
 

Looks like you've gotten pretty good advice, so I'll just add my $0.02

Finding a doctor closer to you is something you should probably do sooner or later, but it won't affect her quality of care. I'm sure the doctors both near and far are qualified to handle this problem. If they're not, it's a whole other problem. Basically, it's a matter of convenience for both you and your mom. Why should you have the added burden of an additional hour of travel time?

A nursing home is a last resort, IMO. It's for when you (or people you hire) just can't provide the care your mom needs. Otherwise, no one will care for her the way you do. And as someone else pointed out, medical facilities are great places to pick up an infection - they're filled with sick people.

Call the doctor today about the home healthcare? Hell yeah!

They're doctors; they work 24/7/365. In addition, in my experience things like home care can fall by the wayside in many cases. It may be that your doctor is expecting you to take care of that and has done nothing to contact them. Unless he specifically stated that he would be arranging it, I would assume he's doing nothing about it. And even if he did say that, I'd follow up to see what the status is.

Also, my theory is that as long as you're polite and professional about it, it's A Good Thing to let the providers know you're the type of person who stays on top of everything (regardless of anything else, including holidays) when it comes to her care. I believe it keeps them on their toes.

As far as going to the ER, it seems the consensus is that it's not needed unless you see signs of infection. At least, that's what I got out of the other responses. However, you do want to stay on the whole home healthcare thing. I don't think the ER is the best place to hook up with a social service worker, but you definitely should see what you can do to get social services involved with helping you arrange and coordinate that.
 
Call, call often until you get satisfaction. Sounds like constant care and monitoring is in order, and while it be best that the original surgeon be in play,,, sounds like you need to consult with one again and soon. Damn the holidays....
 
Woodman909 said:
Call, call often until you get satisfaction. Sounds like constant care and monitoring is in order, and while it be best that the original surgeon be in play,,, sounds like you need to consult with one again and soon. Damn the holidays....
Click to expand...

I put in a call to Home Healthcare. Someone is to call me back. The doctor's staff wrote the order for it Wednesday, and I haven't heard from anyone yet. Supposed to hear last Wednesday or Thanksgiving morning. I also paged the doctor. Believe it or not, one needs a damned prescription for saline solution. Really????? It comes in a spray bottle without prescription, but it's pressurized. The doctor just flowed it from a bottle over the wound to flush it. I don't like the idea of spraying pressurized saline into the wound. Seems to me it would result in driving any bacteria further in rather than flushing it out. ??

(Excuse me for thinking out loud. But I do find this very helpful.) Thank you for your response, 909.
 
sorry I cannot provide any educated advice. Hang in there.
 

She's probably doing ok with your care, but if you are this worried and if it's covered I agree - take her to the ER. It's their job to evaluate it, not yours; they need to decide if what you're doing is working or not working. And you don't want to wait until Monday.

I know ERs are dreadful, but yeah. Do it.

In terms of doctors 45 min away - I feel your pain! we have limited medical services in our town; we have an ER, but any surgeries have to be done in towns either 60 or 90 mins away. If she isn't in love with her doctors and you can find equally good care closer, I would do it. But I guess the question is how long will you be needing to take her to doctors -I don't know the full situation, and hate to be callous, but if she has another few months, I would probably stick with existing doctors. But if, hopefully, she has many years, I'd find some closer.
 

Mak, I did put in a call to the doctor. The Ace bandage is just to hold the dressing in place. You were right. Thank you for reminding me to ask the question. I feel much better knowing that. With someone 86 years old, it doesn't take too much compression (I don't think) to impair circulation. There's so damned much we don't know about our own bodies...never ceases to amaze me.
 
One more suggestion, it sounds like you are doing a fine job, just take it easy.
 

I was going to say that a lot of times those wounds can look a lot nastier than they actually are. I feel for you. It's not easy caring for a sick parent.
 
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