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Primary Care: We started off using a dressing called (Promogran), which is a collagen dressing. After a couple weeks of using this, I was switched to (Aquacel) which is a sodium alginate. From day one we were always instructed to add sterile water to these dressings to "activate" them. I could understand doing this when my wounds were small and didn't have a lot of exudate (drainage.) As time went on without healing, the wounds became one and started to have more and more drainage. We were still instructed to "activate" the dressings with water. At this point my wound was a stage 3.
The Experience: Of course, with all the added water and the drainage itself, the wound began to masurate. The edges also rolled in to meet the edges of the wound itself, saying to the wound that it's closed, we did our job. I was talked into letting my doctor debride the wound, and remove those edges. I understood that this needed to be done, the way that they wanted to do this was the only unsettling part to me. My doctor actually cut into my healthy tissue right above the masurated edges. It was a traumatic experience for me, I was there for hours waiting for the bleeding to stop. And to no avail, the masurated edges were back the next day.
My Angel in Disguise: Down at my sci doctor's office, a nurse practioner, Dawn, was involving me in this "Wellness Program." It's just an organization to educate people with SCI and spina bifida, and to help them get the things they need if insurance companies won't help. Thankfully for me, her background is solely wound care. She came to my house and looked at my wound. The first thing she said was that if we get those edges off she thinks my wound has a chance to heal without a wound vac (there has been so much discussion about using a wound vac on me, thankfully I always got out of it.) She noted of what a choppy job my wound doctor did on the debridement, and that she has never heard of "cutting" masurated edges off, but rather to burn them off using Silver Nitrate. She also had a lot to say about the dressings and how they were used on me. First, she said that Promogran should have never been used as the first dressing, it's not necessarily meant for wounds with little to no drainage. Second, she said Aquacel, in her knowledge is never supposed to be "activated" with anything other than the wounds drainage. She called many nurses that she was close with, and ultimately called the company who manufactures this dressing. They all said that nothing is ever supposed to added to this dressing. She wanted to try the Silver Nitrate and see if it would work on my edges, she said to see what my wound doctor has to say about it.
Bad Doctor: At my next appt. with my wound doctor I wanted to bring this idea to the table. Since I see the nurses first, I told them of Dawn and what she wanted to do. They were all taken aback by this and said that Dr. Jacobson wouldn't like this idea. When they left, I looked to my mom and said that I wasn't even going to tell the doctor about it, I just had a bad feeling. My doctor came storming in my room, "What does this lady want to do to you?" As I begin to tell him, I say Silver Nitrate, and he interrupts me, "Ohhh you can do that but it is absolutely of no recommendation of mine." He was in my room for maybe 5 minutes, ended up basically yelling at me(swore and everything!) then stormed out of the room and slammed the door. After this episode my mom and I thought it would be a good idea to get my medical records. My mom made friends with one of the secretaries and she got me my records from this office along with every picture they took of my wound, legally of course.
The Note 6/6/11: Dawn came over with papers for me to sign one night, and looked over my records with me. Thank god she did. A single note was the very last page of my records, a note from my wound doctor, and a vicious one at that. My doctor wrote that my mom and I have always been non-compliant with recommendations and with dressings. The I refused the surgical debridement for the edges and wanted some nurse practioner to burn them off. I did refuse the surgical debridement for the second time. I would not let him cut me like that again, no way no how. He wrote that "unfortunately the patient has refused all of our dressing recommendations." That he has had the wound almost closed multiple times throughout the past 9 months and it was because of our non-compliance that it hasn't closed. And that "We had a long discussion with the patient and her mother WHO IS IN THE ROOM." The time stamp on this note proves that when he stormed out of my room, he immediately went to his computer and typed this up. He also said in the note that he recommended we seek care with another physician, which he never said to us.
Out With the Old, in With the New: I was enrolled in the Hyperbaric Oxygen Chambers at the time. I had to go to these treatment 5 days a week. Not once in a 2 week time period did anyone ask to see my wound. My mom is a LPN and has always done the dressings herself, so she changed my dressing every morning before the chambers, and when I went to see the wound doctor (literally 5 steps across the hall.) We eventually were seen by a nurse, and also picked a new wound doctor, in the same office, to take over my treatment. This doctor's (he's a surgeon, the old wound doctor a D.O.) idea of debridement is to simply take off the dead, masurated tissue alone. Very simple, no blood, and the edges still barely there. Along with the new doctor, we have been using the dressing the correct way and whodathunkit, I'm healing!! :)I guess wounds heal from the width in and then the length of it heals. Mine went from width 3.1 to 1.2, and depth of 1.7 to 1 in a matter of a couple weeks. This doctor as well says that my wound has a very good chance of healing on its own, no wound vac needed.
Lawsuit: So we're left to strongly believe that if we were using the dressings the right way from day one, I would have been healed a long time ago.. My wound pictures show that I've always had a very pink wound bed with 50% granulation (at first) and then went up to 75-100% granulation (late middle-end of records.) The only thing standing in the wounds way was all the water that was being added.
Anyone can go on the manufactures website for the dressing (Aquacel) and see the illustration of how this dressing works. No where does it say to add water to anything.. the drainage is what's supposed to activate this dressing, nothing else. Every time we added water to it, it pretty much cancelled out the dressing, making it ineffective.
Any thoughts or ideas on this matter? I'm connected with a medical malpractice lawyer, I'm just worried about how things are going to work out. Anyone ever have a similar issue with a wound doctor? I have been dealing with this wound for almost a year now, and I feel cheated out of so much. I had to quit going to physical therapy. I couldn't do a lot of school work, because I couldn't be up doing it (laying on your belly, on on your elbows is hard to do for lengthy periods of time). I just couldn't be out doing like anything.. because of his mistakes. And just all the dealing with it.. all those medical supplies.. ahh.
And I guess this could serve as an update to my wound
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