amaya at lake

amaya at lake

Sunday, January 13, 2013

Wound care follow-up

     Last Thursday we had our follow up appointment with the wound care doctor. It had been three weeks since we had first seen him. After an hour long wait we went back into the room. This time it was full of other patients (Amaya was the youngest, by several decades). Amaya got up on a bed to wait while the doctor saw the other patients. When the nurse came over she measured and photographed the heel again. She said it looked bigger to her, and in fact it measured at 3 cm in width and length. Last time it was at 2 cm. Its now going up the back of her heel. I wasn't sure what that meant. I let the nurse know that the heel seems to be more sensitive and painful for Amaya now. Amaya said her pain there is at a one or a two at times.
      After about thirty minutes the doctor came back. He reviewed his notes from the last time he saw her. He said that it was "a stage two pressure wound" with fat atrophy. When he looked at her heel he said he wasn't concerned with the increased size of it. He said sometimes that's a sign of healing. He said that what had really bothered him last time was the texture of it. He said he could tell there was some healing, and he was quite happy with that. He said the area that has texture that he isn't happy with has decreased in diameter. He said it looked better, but that we were "definitely not out of the woods." He said that children's bodies do a great job of healing. He said it looked liked her body was responding to the foam and healing on its own. He said that she could wear the boot around the house and when she wasn't doing long distance walking. Last time he told us she would have to wear it 24/7. As of today we are still waiting for the boot. I'll be making follow up calls in the morning to see if there are any updates on the boot. He said she should continue to wear the foam every day. They noticed that her heel was very dry and suggested that I start adding lotion to the area before I apply the foam. They gave me a new foam that's pink on one side and white on the other. They said that this foam wouldn't pull so much moisture from the area and dry it out. This foam doesn't seem to stay on her skin very long. The first day she wore it it came off three times.
     Although the doctor was happy with the healing he saw he said that we should keep our appointment with the plastic surgeon (in a week and a half) to see what options he/she can give us. He did caution that because of where the bedsore is located that could be problematic for us. He wants to see Amaya back in four weeks to see if the healing has continued. At that point it would be eleven months since she first got her bedsore. He said that if the heel hasn't improved by then we might have to talk about restricting her movement. He didn't say what that would be. In my opinion that would be counterproductive to what we're doing at therapy, so I hope it doesn't get to that point. He wondered if she was modifying her walk because of her heel (pain and discomfort). She turns her foot inward and walks almost pigeon toed. It's one of the many unknowns we are working with.
    Before we left the doctor asked me if I was happy with the surgery she had (the lengthening). If overall I was happy. I didn't hesitate to say yes. I'm very pleased with the care Dr. Nelson gave Amaya, how her hip has been corrected, and the length we achieved. The bedsore and the muscle atrophy aren't fun and a major hassle to deal with. But of all the complications we could be dealing with I can't really complain.

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