Icky
 

I have a very, very good friend. I'll call her crazynurse. She was a nurse to crazy people, is not herself significantly crazy, although she is quirky.

Anyway, crazynurse is the reason I ended up working at the nuthouse. She got forced out by them several years ago, shortly after she had double knee replacement surgery. She's a good person, and a very good friend.

She just turned 65. I was at her home for a huge surprise party her daughters threw for her.

She has had mobility problems for years, and the knee replacement didn't help very much. Just as she was healing from the knee replacements (this was after the nuthouse fired her), she had a bloodclot in her leg. She was treated with blood thinners, but the hospital where she was didn't manage her dosing properly, and she leaked blood into one leg, causing nerve damage before the doctors figured out what was going on. So, her mobility problems got worse, although she was getting around with a cane okay.

Alright, so then her kidney function declined more rapidly than expected. she has been on dialysis the last couple of years.

Oh, did I mention that she is extremely overweight and had non-insulin dependent diabetes? I don't know what she weighs, although she often claims that she has lost weight ... quite honestly, I've never noticed it. (as an aside, overweight people suck at estimating other people's weight. She could be anywhere between 250 and 400 pounds for all I know)

So, that's the background.

Last week I find out that she's been having some wound healing issues ... ulcers on her legs, and something about an open sore on her heel.

Foot wounds and diabetes are not good. Really not good. Little did I know that it had bypassed really not good and headed straight into scary not good territory.

I get a call from her on Saturday night. If I weren't already out at someone's house (and without my car), I would have been over at her place in a shot.

youngerdaughter (who is now over 30, I've known the kid since she was still in diapers) got rushed to the ER from work on Saturday because she was hemmorhaging vaginally. Near as I can figure, what she was doing was having an extremely heavy period, but what do I know?

Anyway, crazynurse, being a good mom, heads on over to the ER.

She told me that as she was in the driveway just about to go into the ER, she heard a "popping noise," was unable to support herself, and fell.

She was unable to get up. This is not a recent issue. For as long as I've known her she's not been able to rise from the ground ... I was with her once when she slipped on ice, and it required several neighbors and both of her kids and their boyfriends to get her back to standing. Anyway, a passer-by got help for her and she was taken into the ER.

This is where I first learn of the extent of the wound. Apparently this "little open wound" has exposed her Achille's tendon. As if that's not icky enough, it's draining constantly and is foul smelling (drainage can be moderately okay, but foul-smelling is definitely bad). The ER doc redressed her wound (or rather had someone else do it), did no studies or radiology, and sent her home. supposedly the tendon was intact. I say supposedly mainly because, although improving, the hospital in question is not known for astute and accurate diagnoses.

I arranged to go over to her house yesterday, and since it's summer and too hot for chicken soup, I took ... Ricotta White Eggplant Pizza (from Via Veneto, in case you were wondering UT).

In addition to being able to spend time with her and be supportive, I was going to do the things her daughters should be doing for her ... both of them and their husbands live with her, but aren't always terribly good about helping her. olderdaughter has a crazy idea about moving to Saint Louis (no job, no prospects of one, doesn't know anyone there), and is there right now. 10 yard penalty for her of not immediately cutting her trip short and returning home on learning what happened to crazynurse. She's not expected home until late this week. youngerdaughter, despite being in the house, is resistant to doing anything for crazynurse. I was there to help crazynurse with showering, for example. At least youngerdaughter did take care of the icky bits ... the dressing change on the wound.

So, the wound.

It's all kinds of awful.

This "little" wound is actually about 2 cm x 3 cm, and you can see the exposed tendon and the fat layer and other medical stuff I can't identify. there's some shit hanging out of the wound that I'm pretty sure should be attached more firmly to something else (which is why I worry about the tendon). And it does smell to high heaven. crazynurse has been going to a wound center, but I'm doubtful that they've been sufficiently aggressive about treating it. She was supposed to approach her dialysis team about it today and was going to try to get an emergency appointment at the wound center.

I have cellphone pictures, but the focus is poor, and they are really, really icky, so I'm not going to inflict them on you.

I am fearful that things are probably close to the point where crazynurse is looking at an amputation. It's more than just the bigass hole ... she has ulcers on the front of her lower calves, although those do seem to be resolving, and the overall quality of the skin of her lower legs is really, really poor. It's not healthy-looking or pink. Dry, scaly, and grayish brown is not generally what lower legs look like. On a living person.

I am going to check in with her this afternoon and give her the name of the best diabetic wound care guy in the area. I got his name from my friend, tatadoc.

Geez - so sorry to hear that. I hope that they get this all sorted out.

oh ugh. Banana Lady has diabetes and is not overly sylph-like. She seems to trip/fall rather too regularly and the wounds she gets from seemingly simple scrapes can be atrocious. She's here now, just finished recoving from the last fall (a long time ago) so we're trying to get a new exercise regime/weighloss program started and ingrained before she goes back. Took her for a birthday Pedi today because she said she wished her toenails were pretty like everyone at the pool. I think she enjoyed it and her feet and lower legs look much better for it.

Best wishes for your friend and thank goodness she has you.

That does sound pretty nasty. I hope they get to it in time.

monster, you have a brave pedicurist. Most of them won't touch someone with diabetes because of the risk of infection and wound healing issues. However, diabetics can get a pedi from their podiatrist, and insurance will pay for it ... although I don't think he will let you choose petal pink!

I will be taking her to an appointment for a vascular study of her lower extremities on Thursday. youngerdaughter and olderdaughter are not doing this. I do not know why.

I dunno about that wolf. My wife gets pedis all the time and she has lifelong Type II diabetes. And ingrown toenails. And sensitive feet. It takes her a while to find an acceptable pedicurist but once she does, she clings to them like a monkey on a vine. I have never heard of her getting rejected due to her diabetes.

not the case, we found, wolf.

1) they do not care. But Banana lady watched her like a hawk because she cares. They did not ask anything, were not concerned when BL told them be careful with the clippers because she was diabetic. They just want the business.
2) Visitor from UK = no insurance. In the UK she does get free "pedicures", but they're medical ones, not fun ones. No massage and no polish, just a clip and grate.

...and I gotta say, that's the best $30 I ever spent! She's gone from nasty feet she's ashamed of to showing off her tootsies at the pool to all the other Pedi fans and non-fans alike. Anyone, in fact! She's loving it.

...I even think it might have made her more aware of her feet -she seemed to be walking better this evening..... could be wishful thinking, though....

So, no Happy Ending, then?

She needs to get that thing debrided, a wound vac on it, and hyperbaric treatment if possible. From the sounds of it, without seeing the pictures, it is stage III or IV and she is very likely to lose the foot, if not undergo a whole BKA. That thing is a MRSA, sepsis, or gangrene infection waiting to happen, which could easily kill her. Many of my patients at the private EMS company have such wounds, and they need regular, specific attention in order to ever heal up.

Do you have an update, wolf?

I think I have her convinced to see a wound care specialist. We go tomorrow morning for a vascular study.

What I didn't know was this thing went from a small blister to the monstrous wound I saw in the space of less than a week.

She says they tested her for MRSA and claims that all the tests came back clean.

Yeah, right. Little bitty kittens are cozying up to her every night and eating her flesh. Of course it's fucking staph or something.

tatadoc isn't sure if she'll be able to "dive" given her weight. I already asked my friend if they suggested a wound vac and she said, " a what?"

Send her this ...

huh? I'm missing something here. "dive"?

dive is reference to a trip to the hyperbaric oxygen treatment chamber.