040929 - ..
040930 - Lana compared wound condition today, with picture of wound
040931 - taken by Doctor Lucy Kornblith last Friday on 150925...
040932 -
040933 - 
040935 - ..
040936 - Lana advised that the wound today has evident increased infection and
040937 - inflammation.
040939 - ..
040940 - Lana is concerned that "undermining" of the wound has worsened
040941 - conditions, causing increased infection. She measured underminging
040942 - and marked this area on the skin around the perimeter of the wound,
040943 - shown in another photograph she took today...
040944 -
040945 - 
040947 - ..
040948 - Excessive undermining may have occurred on the 2nd dressing of the
040949 - wound on 150925, indicated in photograph...
040950 -
040951 - 
040953 - ..
040954 - The record reports increased pain occurred during this procedure,
040955 - reflecting flesh being separated with possible over-packing with strip
040956 - gauze dressing, reported on 150925 0336, ref SDS 2 YS5I
040958 - ..
040959 - Today, Lana cleaned the wound with saline solution. She then packed
040960 - the wound with Hydrofera Blue Bacterostatic Tunnel Dressing, which
040961 - Christy initially used last Friday on 150925 0336. ref SDS 2 XN5L
040963 - ..
040964 - At that time, research indicates Hydrofera Blue dressing can be
040965 - effective for 72 hours (3 days) before changing, reported also on
040966 - 150925 0336. ref SDS 2 HM5I
040968 - ..
040969 - Today, Lana advised she will use a different bandage pad to cover the
040970 - Hydrofera Blue Tunnel dressing, switching from Mepilex Border applied
040971 - last Friday on 150925 0336, ref SDS 2 IA6M, to a new product...
040972 -
040973 - Enluxtra Wound Dressing
040974 - Re-order number................ AWD-5-1010
040976 - ..
040977 - Manufactured by: OSNovative Systems
040978 - 500 Laurelwood Road
040979 - Santa Clara, CA 95054
040980 - 888 519 2297
040981 -
040982 - http://www.anywound.com
040984 - ..
040985 - Lana explained that Enluxtra is an "adaptive" wound dressing that
040986 - speeds normal healing process.
040987 -
040988 - [On 140101 0600 case study on exercise, diet, medication
040989 - and vitals, reported hiking on 160429 applied Enluxtra
040990 - dressing on wound at achilles heel. ref SDS 1 G66M
040992 - ..
040993 - There is a video explaining Enluxtra at...
040994 -
040995 - https://www.youtube.com/watch?v=95M9mJMQwZE
040997 - ..
040998 - After placing Enluxtra pad to cover Hydrofera Blue Bacterostatic
040999 - Tunnel wound dressing, per above, ref SDS 0 XI5O, we then wrapped the
041000 - leg with 4" gause roll, and then covered that with 4"
041001 - elastic-self-adhering bandage (think "Kobin"). Secured these bandage
041002 - wrappings with cloth adhesive tape wrapped twice around the leg to
041003 - hold everything in place during hikes. Finally placed stretch tube
041004 - netting over the bandaging to help prevent adhesive tape from
041005 - unraveling.
041007 - ..
041008 - Discussed hiking for wound therapy. Lana approved 2 - 3 miles daily
041009 - hiking until next examination on 151005, and in order to maintain
041010 - blood flow to wound that stimulates recovery. She prescribed rest
041011 - with leg elevated after hikes.
041013 - ..
041014 - Lana prescribed customer will change Enluxtra dressing pad, but not
041015 - Hydrofera Blue Tunnel dressing tomorrow and on Wednesday. Return to
041016 - Wound Clinic on 151001 (Thursday) 1200. Lana will change Hydrofera
041017 - Blue Tunnel and Enluxtra dressings.
041018 -
041019 - [On 150929 0810 customer changed wound dressing for
041020 - Enluxtra pad and left Hydrofera Blue Tunnel dressing in
041021 - place, as instructed. ref SDS 3 VT6K
041023 - ..
041024 - [On 150930 0737 changed Enluxtra pad again covering
041025 - Hydrofera Blue Tunnel dressing, as instructed. ref SDS 4
041026 - VT6K
041028 - ..
041029 - [On 151001 1200 Lana changed Hydrofera Blue Tunnel dressing
041030 - and the Enluxtra cover pad, ref SDS 6 LY79; she found
041031 - infected tissue along the edges of the wound, and so used a
041032 - surgeon's scaple to cut this tissue so that healing will
041033 - not be impeded; this caused considerable pain. ref SDS 5
041034 - NC9G
041036 - ..
041037 - This work plan aligns with research indicating Hydrofera Blue dressing
041038 - should be change within 3 days, reported on 150925 0336. ref SDS 2
041039 - HM5I
041040 -
041041 -
041042 -
041043 -
041044 -
041046 - ..
0411 -
0412 -
0413 - 1247
0414 -
041401 - Drove home, and on arrival received call from Doctor Rao. She asked
041402 - about progress recovering from hematoma wound on lower left leg?
041404 - ..
041405 - Reported good progress found by Nurse Svetlana in Wound Care, per
041406 - above. ref SDS 0 X67K
041407 -
041409 - ..
0415 -
0416 -
0417 - 1330
0418 -
041801 - Took another set of pills for infection and pain, but discovered there
041802 - are not enough to perform the 7 day prescription.
041803 -
041805 - ..
0419 -
0420 -
0421 - 1338
0422 -
042201 - Called Doctor Rao's office to return her call earlier today, per
042202 - above. ref SDS 0 QH5I
042204 - ..
042205 - Left message reporting error in medication quantities insufficient
042206 - for 7 day prescription.
042208 - ..
042209 - Called MP Clinic. Doctor Rao's nurse, Cassandra, said the doctor will
042210 - not be onsite until Wednesday, so she cannot ask you until Wednesday,
042211 - if an effort should be made to continue medication from Tuesday until
042212 - Thursday, when another review is made by Lana in Wound Control.
042214 - ..
042215 - Called the Pharmacy and talked to Anna.
042217 - ..
042218 - Anna said the prescription to take 2 pills every 6 hours requires 8
042219 - pills per day, so should have received 7 x 8 = 56 pills. The bottles
042220 - say 28 pills to treat infection, and 30 tablets for pain medication.
042221 - Anna was not sure how these quantities were determined, and suggested
042222 - contacting Doctor Rao for correction.
042224 - ..
042225 - Since had already tried to contact Doctor Rao, tried to find a number
042226 - for Doctor Yoo who issued the original prescription, reported on
042227 - 150925 0336. ref SDS 2 BP7K
042229 - ..
042230 - Could not find a contact number for Doctor Yoo.
042232 - ..
042233 - Called Isagani, who assists Doctor Stewart in General Surgery.
042234 - Isagani will try to locate Doctor Yoo to issue new prescriptions.
042235 -
042237 - ..
0423 -
0424 -
0425 - 1549
0426 -
042601 - Sent letter to Doctor Rao saying...
042602 -
042603 - 1. Subject: Medication Recover Debridement Infection
042604 - Date: 2015-09-28 16:28
042609 - ..
042610 - 2. Dear Doctor Rao,
042612 - ..
042613 - 3. Thanks for calling this afternoon about 1300, to ask about
042614 - results of follow up meeting with Nurse Svetlana Nakamura
042615 - (Lana) in the Wound Clinic (Module 2).
042617 - ..
042618 - 4. As we discussed, Lana found wound status today shows continuing
042619 - infection. You can see this comparing pictures Lana took on my
042620 - cell phone today, with the picture taken by Doctor Kornblith on
042621 - 150925 (both attached). Lana further noticed significant
042622 - undermining of the wound, which she marked with a pen on the
042623 - leg in the picture today. This may relate to longer than
042624 - expected infection. During the meeting she cut some of this
042625 - back.
042627 - ..
042628 - 5. Lana removed and replaced Hydrofera Blue Bacterostatic Tunnel
042629 - packing of the wound. She changed from Mepilex Border dressing
042630 - applied on Friday, to Enluxtra wound dressing in order to
042631 - reverse evident advancing infection. Lana submitted 2 each of
042632 - Enluxtra wound dressing packages, and instructed to leave the
042633 - Bacterostatic Tunnel packing in place, but replace Enluxtra
042634 - dressing tomorrow and Wednesday in order to observe if
042635 - additional seepage occurs, and in that case I am to return to
042636 - the hospital for further assessment. If seepage seems stable,
042637 - then return to the hospital on Thursday, and meet with Lana in
042638 - the Wound Clinic at 1200. If infection has not improved, Lana
042639 - will make referral to ER for consideration of additional
042640 - debridement, as discussed in the letter to the team earlier
042641 - this morning, shown below.
042643 - ..
042644 - 6. About half hour after you called this afternoon, at 1330, it
042645 - was time for another round of medication for infection and pain
042646 - control. Current prescriptions entered by Doctor Jason Yoo on
042647 - 150925 include...
042649 - ..
042650 - 2 pills Hydrocodone 5 MG with Acetaminophen 325 MG RX 90421826
042651 - prevent pain every 6 hours or as needed
042653 - ..
042654 - 2 pills Clindamycin HLC 150 MG RX 6101596 prevent infection
042655 - take every 6 hours
042657 - ..
042658 - 7. In taking these pills today, noticed there are 4 pills
042659 - remaining for Clindamycin, and 7 pills remaining for Hydrocone.
042660 - At the prescribed rate, this will last to midnight for
042661 - infection control, and tomorrow morning for pain.
042662 -
042663 - [On 151001 1200 Doctor Yoo issued new order for Hydrocodone
042664 - 5 MG with Acetaminophen 325 MG RX 90421826 to complete 7
042665 - day prescription. ref SDS 5 CE51
042667 - ..
042668 - 8. Tried calling you back to ask if medication should be stopped
042669 - tomorrow until Thursday, or can refills be ordered and
042670 - delivered in time to be effective? Left a message, but not
042671 - sure if I had the correct number.
042673 - ..
042674 - 9. Called your office in the MP Clinic. Your nurse, Cassandra,
042675 - advised that you will not be onsite at the VA until Wednesday,
042676 - so she cannot ask you until Wednesday, if an effort should be
042677 - made to continue medication from Tuesday until Thursday, when
042678 - another review is made by Lana in Wound Control.
042680 - ..
042681 - 10. Cassandra seemed to say the VA computer system indicates I
042682 - should have received medication for 7 days.
042684 - ..
042685 - 11. Called the Pharmacy. Anna in the Pharmacy calculated that the
042686 - prescription to take 2 pills every 6 hours requires 8 pills per
042687 - day, so a prescription for 7 days cited by Cassandra, should be
042688 - 7 x 8 = 56 pills. The bottles say 28 pills to treat infection,
042689 - and 30 tablets for pain medication. Anna was not sure how
042690 - these quantities were determined, and suggested contacting the
042691 - primary.
042693 - ..
042694 - 12. Also tried to find a number for Doctor Jason Yoo, listed on the
042695 - medication bottles as having entered the orders. Doctor Yoo
042696 - made the initial examination in Medical Practice OA 1900, and
042697 - continued working with Doctor Kornblith on this matter. I know
042698 - his office was around the corner from my room in Med Surg, but
042699 - have been unable to find a number for him or Doctor Kornblith.
042701 - ..
042702 - 13. Also called Isagani, Doctor Stewart's assistant. He has always
042703 - been resourceful on logistics issues involving surgery.
042705 - ..
042706 - 14. Should I continue current prescriptions, or stretch out
042707 - supplies to last until Thursday? Can switch to ibuprofen for
042708 - pain. Seems like infection is the more important problem to
042709 - solve, according to Lana this morning. Hoping medication can
042710 - just end after supplies expire.
042712 - ..
042713 - 15. Sorry to burden you with ancillary details, especially after
042714 - making great progress with debridement surgery last week.
042716 - ..
042717 - 16. Please call when time permits.
042718 -
042727 -
042728 -
042729 -
042730 -
042731 -
042732 -
042733 -
042734 -
042735 -
042736 -
042737 -
042738 -
042739 -
042740 -