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December 28, 2007
Not to take everybody on a rollercoaster ride, but I just got finished seeing Wes and unfortunately, we're not out of the woods yet; not by a longshot.
His actual surgeon, who is caring for his leg, is out of town for the holiday, so I'm just filling in, mind you, but I have some strong concerns. I'm not going to get into too much detail, but we've made some adjustments and Wes will be calling me in 24hrs to let me know how he's responding. I will bring in the on-call surgeon over the weekend to see him in the ER, if necessary, but, in any event, he's supposed to see the original surgeon for a follow-up, upon his return, on Tuesday.
We'll see how this is doing and know more tomorrow and more again on Tuesday.
Keeping Wes in your prayers would not be inappropriate. We've got a ways to go here, Pards, and sofar the road is not being as smooth as I would've liked, but we're working on it.
Sorry for the less-than-great news, but Wes wanted me to keep you all informed, and that means the good as well as the not-so-good.
--Doc M
December 31, 2007
I just got back from visiting Wes/West in the hospital.
Again, he requested that I let everybody know everything that has been happening with him. So, here's the update as of this afternoon:
As I'd previously posted, when I saw Wes' leg (for the surgeon) on Friday, I didn't like the way that it looked, but, in consultation with the Orthopedic Surgeon on-call, we made a decision to change his antibiotics and see how things went, with the thought that we would probably put him back into the hospital and he would be in to see him if there wasn't a significant improvement within 24 hrs.
Well, the next day, I receive a telephone report from Wes' wife, that he was in a lot of pain, and other symptoms which immediately prompted me to send him back to the hospital. I called in the on-call Ortho Surgeon (whom it turns out, Wes knows.) and basically set up an ER evaluation. It was decided that there was a need for vascular consultation (blood circulation problem) and the Vascular Surgeon(whom Wes ALSO knows) was called in. He felt that there was indeed a blood flow deficiency and the decision was made to attempt improvement, either by the insertion of Stents or by Bypss Grafting, depending upon exactly what was found at the time of the arteriogram. Ultimately, the arteriogram revealed a number of blockages, aswell as some other abnormalities, and stents (5 of them!!) were placed last night(12/30). The blood flow to the limb is now greatly improved. Consequently, Wes is having considerably less pain, though he is far from comfortable, and he clinically looks MUCH better to me, with more color in his face and an overall better mood, affect, and humor. He's even joking around a bit, and more like his usual self, which was certainly NOT the case on Saturday.
The surgical site is still draining and he is still running a bit of a fever. It will be a matter of time to see whether or not the improved circulation will be sufficient to allow the current amputation site to be salvaged. I am, at this point however, more optimistic than I was on Friday and Saturday. I have also called in a Plastic Surgeon who is a specialist in Hyberbaric therapy and he will be seeing Wes on Thursday...unless I can get him in there sooner.
Again, Wes sends his regards and gratitude for all of your kind thoughts, prayers and support. He can't even begin thinking of work right now, and I want him to concentrate everything on getting well, but he will get back to it ASAP, when his condition allows.
That's the whole of it sofar. I will continue to follow with updates as they unfold.
A Happy New Year to all of you.
---Doc M
January 4, 2008
Appreciate the thanks, Pards (Thank you), but really, there is no need. Wes asked me to keep you all informed, and letting family members know about patients' conditions is part of what I do. It's certainly the very least that I can do.
So, along those lines-
LATEST UPDATE:
Since the stent placement, I am happy to say that Wes' leg has pinked up quite a bit, and he's been in less pain. Gayle called me today and said that he got a better night's sleep last night, and is a little more energized today. There has, of course, been some tissue loss, due to the initially low circulation, at the surgical site and there is still some infection , but the cultures have returned and the antibiotics have been adjusted appropriately. The TWO orthopedic surgeons plan to debride(remove) the devitalized tissue, which should help eliminate the infection, and attempt a primary (sutured) closure of the wound this weekend, if there remains enough tissue. Both of them and the vascular surgeon, however, are sufficiently pleased with the response to the stent placement that they are optimistic (at least at this point anyway) that the current amputation and flap may well be salvageable. The prognosis on that is still a bit guarded. We will know more after this weekend. I'm going over there to visit him now. More updates to follow in time.
January 10, 2007
Wes is just out of Surgery, still in Recovery. The surgeon debrided his wound(removed dead tissue) and attempted a closure. He was able to perform a 50% closure, but the flap had shrunken and lost too much of its tissue to allow him to close it completely. This will slow the healing process, as the wound will have to heal by what we refer to as "Secondary Intention." That is to say, that the open areas will have to granulate or "scar" in. This takes longer and can be a little more susceptible to infection but does allow for drainage. The good news is two-fold this time: 1.) There was no clinical evidence of active infection at this time, and 2.) The Surgeon commented that the blood perfusion to the area looked good...Also, we are still talking about staying BELOW the knee here, and that would be a VERY good thing indeed.
The vascular surgeon says that the stents are open and the level of blood flow to the leg is as good as can be attained at this time, at least to the larger vessels.
What remains now is Post-op recovery, healing, and rehab, etc. We will be watching Wes very closely through these stages.
Regarding the post that I made about the bad phone call that Wes got: Please note that as far as I know, that was only ONE call. It came from (as I originally suspected) a NON-CAS customer who was completely unaware of Wes' predicament. Given that set of circumstances, I can fully understand his consternation and frustration, but as it turns out, he's really a nice fellow. Once I got onto the phone and explained it all to him, he felt AWFUL, not only for his call, but also for Wes' difficulty. It's all handled now...Please put the ropes away.
More updates to follow as they are available.
--Doc M
January 15, 2007
Well, things are progressing. The Wound Suction Device that was originally placed on Wes' leg after the last surgery, had to be temporarily removed after the first night due to bleeding from some smaller vessels in the wound. The good news about that is that it boded well for the viability of the circulation at the site. The suction device was reapplied after the bleeding stopped and things had had time to stabilize. I'm very happy to say that it has reduced the swelling enough to allow for a second closure surgery, the purpose of which is to attempt to more fully close the wound, tomorrow(Tuesday). The circulation is looking good enough to do that now. This is good news. The surgery will be at about 2:30 in the afternoon.
Gail as well as several other members of Wes' family have not been in to see him because they have colds(It's just that time of year in Tucson.), and I suggested that, with everything else and being bedridden, he really doesn't need to also be bombarded by any extra germs right now. In fact, I was going to go over there tonight, but I, myself, awoke this morning with a scratchy throat and slightly stuffy nose, and decided that it would be better if I just called him instead, and he wisely agreed.
Wes is in better spirits now too. I stayed for awhile the other night and we watched the Miranda/Banks fight on the tube. ( Holy Cow! Did anybody else see that KO punch!?? Whadda shot!) Wes, without much else to do, is also eagerly looking forward to the second 2hrs of Comanche Moon tonight...I suggest to please not call him during the show!! Flat on one's back, the little things matter more than we realize! Hopefully, he'll be recovered enough from the anesthesia, by 8PM, to be able to follow it.
He's still got quite a way to go, but the news right now is improving. Suggest keeping up the prayers. Something's working.
More updates to follow as available.
---Doc M
January 19, 2007
Saw Wes tonight. The surgery this last weekend, so far, has been successful. The wound was closed the remainder of the way, and the wound suction device is continuing to do its job. Wes has been transferred to a sub-acute facility. The original blisters from the now improved, poor blood flow have evolved to ulcers, but appear to be drying and healing, albeit slowly. The wound edge looks good, but there is concern that the infection is either still present or recurrent and is with a resistant bacterial strain. Nevertheless, the overall appearance of the area appears improved.
Wes has been up on crutches a bit, and there is more emphasis being made on his Rehab.
I will be in closer contact with his Sub-Acute physician now, in an effort to lend some input.
Wes is in better spirits too.
He again sends his regards and thanks for all your prayers and support.
More updates to follow as available.
---Doc M
January 25, 2008
I saw Wes last night.
I wish that all that I had was good news, but not all of it is. It is, at best, mixed.
Wes has been in a Sub-acute (a stepdown facility) for about a week now. The infection in his leg was resistant to the vancomycin, but tested sensitive to another antibiotic, and he's been on that for several days now. The sub-acute/wound care physician at the facility, under direction from the orthopedist, removed the sutures at the amputation site, and, unfortunately, the wound opened and the flap slipped down. It is packed and dressed now, but still draining. His pain is under better control, and he remains in good spirits, but he is understandably frustrated by the setback. He is seeking a second opinion and I have been attempting to assist in that search, but the problem is that the orthopedist, which he has, is part of the largest ortho group in Tucson, and they generally have all of the best people, and other members of the group are loath to step into a case already in progress by one of their own. So I'm putting out some feelers in Phoenix too.
For some reason which is unclear to me, Wes was not taken by the sub-acute staff for his Tuesday ortho office visit, and the vascular surgeon, who was supposed to show up yesterday to re-assess the situation and make some determination on the viability of the flap, never showed. (He may have had an emergency. I don't yet know for sure.) I have put in heated inquiries about BOTH issues with the staff at the sub-acute. Additionally, Wes was spiking a low-grade fever last night, which is of some concern. We've been making more inquiries about hyperbaric chambers, and I found a larger, 6-place unit, here in town. It is not ideal, as it is an older unit which has a submarine type, 36" diameter round door which must be stepped through to gain access, but it would be more suitable for Wes than the single place models which are more common.
The problem will be getting his insurance to pay for it, as it runs $225/session, and Wes' condition at minimum will require 27-35 sessions. I spoke with the Dr there and got it discounted to a flat $5K for the 27 sessions, but that is still a lot if the insurance won't kick out. (BTW- Before anyone thinks that that Dr. is a hard case, let me tell you that she is a neurologist, and has a standing offer for FREE hyperbaric treatment to ANY U.S. soldier who has suffered a head/brain injury in Afghanistan or Iraq!) So we're working on that.
At any rate, Wes' brother and wife and Rattler John are working to get Wes covered and treated under the VA system, which has its OWN wound care facility, and all which remains to get that done is the availability of a bed, for which Wes is waiting now. I'll be looking into a few other things today, in between seeing my patients at the office.
That's the whole story sofar.
---Doc
January 29, 2008
Well, Pards, It's not good. Looks like Wes is going to have to have the amputation shortened to ABOVE the knee. The flap just didn't have enough blood supply, despite the vascular surgery, and the infection just wouldn't clear and allow it to heal. Wes is not happy about this of course, but he is meeting it with resolve. The one postive note is that he has found a new orthopedist/ wound care physician in whom he has great confidence(The old one is OUT of the picture.), and the new ortho will be performing the next surgery AND the follow-up. We are also still waiting for a VA placement.
That is all that I have at this time.
Thanks.
---Doc M
February 4, 2008
Well, Wes was moved back from the Sub-acute facility to TMC and went through the surgery, and that is where he's been since. I was over there on Saturday night, and his spirits were up, and he looked me right in the eye as we shook hands, and he told me with firm resolve, that he was going home after he got finished with THIS one. The surgery had gone well and the site looked good afterwards, with only minimal drainage. Wes' fever abated after the surgery, and that basically confirmed what I had suspected; that the devitalized, infected tissue had been releasing too much toxin into his system and that he was better off having had it removed. His overall color has improved, but he's also still in a lot of pain.
Of course, there has been the ongoing attempt to get him into a VA wound care facility, and he'd only been waiting for a bed to become available in order to do that. GOOD NEWS! He got the bed today, and they transferred him over there this afternoon. He didn't know to which facility they would be transferring him, but he'll be in touch with me just as soon as he gets settled, and then I can get over there and see how he's doing. If it's the facility on the south side, that will work out really well, because that is about two blocks from my office, as opposed to all of the other places sofar, which have been all the way cross-town from me.
Anyway. That's the news up to now. Hopefully, Wes' recovery will be steady and uneventful and we'll see him getting home soon.
More updates as available.
--Doc M
February 13, 2008
Saw Wes a few days ago and spoke with him tonight. Happy to say that he's in good spirits and is doing better. From what I've seen of it sofar, I'm quite favorably impressed with the VA facility, here in Tucson. It is modern and I really like it and the attitude of the staff there, and they are giving Wes good care. The wound looks clean and appears to be healing well. He's been up and about on crutches a bit too. Tomorrow, they will have a meeting with him, to discuss the next steps towards Rehab, which is great, and Wes is really looking forward to it.
So far, so good.
--Doc M
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February 16, 2008
Howdy all
I just saw Wes on Saturday 2-16-08
Wow, wat a surprise to see him roll up in his wheelchair under his own power. When he saw it was me, I got nothin but a great big grin from ear to ear. That is the first I have seen him smile like that in over a month. He was in good spirit and we even went out side to enjoy some of the warm Arizona Sunshine. He is doing much better but still has a long road to go. Wes told me that he may be able to go home as of this Thursday. This will be a big step. Wes also said " Thank You to everyone that is supporting him and Thank You for all of the prayers and blessings".
SixPak
