CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 4 0000. ref SDS 3 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Meeting in Clinic Module 2 planned by Lana during the meeting
040902 - yesterday in the Wound Clinic also module, reported on 151005 0800.
040903 - ref SDS 4 4G9K
040905 - ..
040906 - Prior to the meeting, visited briefly with Lana, who was working in
040907 - another examination room. Lana confirmed that she spoke with Doctor
040908 - Stewart this afternoon, and told her the purpose of the meeting in
040909 - the surgery department is perform additonal debridement, and with
040910 - conscious sedation, which requires performing the procedure in either
040911 - the OR or the ICU.
040913 - ..
040914 - Walking through the hall toward an examination room, visited briefly
040915 - with Doctor Stewart in the hallway. Reported chance meeting yesterday
040916 - with Doctor Wisneski, and her kindness to have extended spot
040917 - discussion on ordering CCTA, reported on 151005 1102. ref SDS 5 5H5N
040918 - Considered strong feelings expressed by Doctor Wineski to avoid CCTA
040919 - testing for response to treatment that would justify reducing reliance
040920 - on drugs in order to reduce side effects. ref SDS 5 RF7L
040922 - ..
040923 - Doctor Stewart smiled and said "You are a free man. You can make
040924 - your own decision based on best evidence."
040926 - ..
040927 - She requested a letter to follow up on these issues.
040928 -
040929 - [On 151029 2257 submitted letter to Doctor Stewart
040930 - presenting request to assist interpreting CCTA on 151019,
040931 - for developing calcium score that was omitted in analyst's
040932 - report. ref SDS 6 4X5I
040934 - ..
040935 - [On 151104 1114 spoke with Doctor Stewart by telephone; she
040936 - received this letter, ref SDS 7 ZS4J, and referred
040937 - interpretations of CCTA test on 151019, to Cardiology
040938 - Department. ref SDS 7 GV6H
040940 - ..
040941 - [On 151119 2141 received letter from Doctor Stewart
040942 - submitting 6 professional articles on CCTA to assess
040943 - response to treatment for regressing atherosclerosis, and
040944 - on severe side effects of statins. ref SDS 8 4X5I
040946 - ..
040947 - In the examination room, met with Clara, an intern specializing in
040948 - reconstructive surgery to repair wounds. She was familiar with
040949 - objective to perform additonal debridement, and to forego scaple
040950 - methods which have caused great pain (e.g., level "20") performed
040951 - without conscious sedation.
040953 - ..
040954 - Initially Clara removed the dressing on the wound. She asked who
040955 - dressed the wound?
040957 - ..
040958 - Explained that Lana in Wound Care Department packed and dressed the
040959 - wound during an examination yesterday here in the Module 2 Clinic.
040960 - This morning, I changed the dressing pad and gauze bandaging, but not
040961 - packing with bacteriostatic tunnel dressing. Lana is scheduled to
040962 - inspect healing progress and change dressing again on Thursday, 151008
040963 - 1200.
040965 - ..
040966 - Clara began by gently pressing on tissue to discover areas along the
040967 - perimeter of the wound sensitive to pain. She used what looked like
040968 - common tweezers to gently press on the tissue, and asked for
040969 - sensations of any kind. There were several places where pain was
040970 - immediately acute. Most of the path around the perimeter of the wound
040971 - had no feeling, which seemed "terrific."
040973 - ..
040974 - Clara then used the tweezers to gently ply or tear what she described
040975 - as dead tissue loose from live skin.
040977 - ..
040978 - Eventually, she described this as "teezing" the dead skin loose. This
040979 - action as performed by Clara was barely noticable. A few places there
040980 - was very brief stinging. When she noticed patient reaction, she let
040981 - up and continued by working this part loose from another angle and
040982 - more slowly.
040984 - ..
040985 - Asked Clara if this work is actually the debridement which Lana asked
040986 - to be performed by the surgery department? Clara said yes.
040988 - ..
040989 - Since there was little to no pain involved with this procedure, asked
040990 - Clara to go find Lana and explain we would like her to observe this
040991 - tweezer procedure that causes no pain, as an alternative to the scaple
040992 - tool and procedure, which Lana used a week ago, and which caused so
040993 - much pain, reported on 151001 1200. ref SDS 3 WW4I
040995 - ..
040996 - Clara left the room, and returned about 5 minutes later.
040998 - ..
040999 - A few minutes later, Lana came into the room. She was very interested
041000 - to see the tweezers Clara used to replace the scaple for debridement
041001 - on this particular wound condition. Lana watched Clara remove a
041002 - little more of remaining dead skin. Clara asked Lana to identify any
041003 - further debridement she feels is needed. Lana pointed to another
041004 - small section, and Clara used the tweezers to remove this additional
041005 - dead skin.
041007 - ..
041008 - Lana was very pleased to see that, since meeting with her yesterday,
041009 - undermining has almost entirely resolved, showing healing is now
041010 - progressing well with the line of care Lana has developed and
041011 - maintained in Wound Care.
041013 - ..
041014 - After observing Clara for a few minutes perform additional debridement
041015 - with tweezers, Lana commented this can be an effective compliment to
041016 - existing practices. She then returned to her patient in Wound Care.
041018 - ..
041019 - Clara described the "dead skin" being "debrided" as just another name
041020 - for removing a scab.
041022 - ..
041023 - Clara left a single dark spot along the perimeter of the wound. She
041024 - wants Doctor Stewart's opinion before removing it. She left the
041025 - examination room to consult with Doctor Stewart.
041027 - ..
041028 - After about 20 minutes, Doctor Stewart and Clara returned to the
041029 - examination room.
041031 - ..
041032 - Initially thanked Doctor Stewart for fitting me into her heavy
041033 - schedule today, after getting the request only yesterday from Lana in
041034 - Wound care. Further thanked Doctor Stewart for providing an "Angel"
041035 - today. Explained that today was one of the best medical encounters in
041036 - patient history. Clara performed debridement with skill and patience
041037 - that avoided pain, completely reversing prior pain level "20" suffered
041038 - doing previous debridement in this case. Seems like a miracle.
041040 - ..
041041 - Doctor Stewart noted that Clara is a significant asset to the General
041042 - Surgery team.
041044 - ..
041045 - Clara asked Doctor Stewart to check the remaining dark spot along the
041046 - perimeter of the wound.
041048 - ..
041049 - On examination Doctor Stewart advised that, like any scab, this will
041050 - eventually fall off in the normal course of healing, but that removing
041051 - it today will advance the healing process. She asked Clara to try and
041052 - remove this last small section of dead skin.
041054 - ..
041055 - The doctor said to schedule follow up examination in 2 - 3 weeks
041056 - evaluating need for additional reconstructive (plastic) surgical
041057 - measures to enable full closure of the wound.
041058 -
041059 - [On 151215 1330 Doctor Stewart commends Lana's excellent
041060 - work in Wound Care Clinic getting severe hematoma on lower
041061 - left leg to fully recover without recourse to surgical
041062 - reconstruction. ref SDS 9 5X5L
041064 - ..
041065 - Doctor Stewart left the room.
041067 - ..
041068 - Clara explained that her speciality is reconstructive surgery to
041069 - repair wounds. When healing does not completely close the wound,
041070 - Clara can use surgical procedures to restore a normal leg condition.
041072 - ..
041073 - Clara then used tweezers again to gently ply this last section of dead
041074 - skin loose to complete debridement.
041076 - ..
041077 - Clara left the room to get dressing supplies from Lana in Wound Care.
041079 - ..
041080 - On returning she asked if Lana uses both pieces of the Hydrofera Blue
041081 - Bacterostatic Tunnel Dressing, and whether they are wet?
041083 - ..
041084 - Explained they are both used to pack this wound and that Lana wets
041085 - them with something.
041087 - ..
041088 - Clara left the room again, and returned a minute or 2 later. She
041089 - brought 2 syrenges sealed in manufacturer plastic packaging.
041091 - ..
041092 - Clara used one of the syrenges to wet the Hydrofera Blue Bacterostatic
041093 - Tunnel Dressing. She then gently packed it into the wound.
041095 - ..
041096 - Since undermining is now almost entirely healed, the bacteriostatic
041097 - tunnel dressing (i.e., packing) would not stay in place, so I used a
041098 - finger to hold it in place, while Clara opened the Enluxtra bandage
041099 - pad and then placed it over the wound to hold the packing in place.
041101 - ..
041102 - Clara then used a role of gauze to wrap the Enluxtra wound bandage,
041103 - securing it in place. Requested she wrap it tightly, so that the
041104 - entire bandaging assembly won't slip down when hiking. Clara said
041105 - most patients want the gauze wrapped loosely to avoid cutting of
041106 - circulation. Explained that hiking 11 miles will cause ample
041107 - circulation, and gradually loosen the wrapping so we have to start off
041108 - tight. Clara then let me do this wrapping step. She added the
041109 - self-adhering elastic bandage wrap over the gause wrapping. Taped it
041110 - at the end to secure the connection. Then added full circule tape to
041111 - hold the bandage in place during activity.
041113 - ..
041114 - Thanked Clara again, noting it was fun working together with such
041115 - favorable outcome. This was one of the best medical meetings ever
041116 - performing delicate surgical procedure that previously caused pain
041117 - level "20", but which today was barely pain level 1. This improvement
041118 - in relieving pain and suffering, and anxiety leading up to the work
041119 - cannot be overstated.
041121 - ..
041122 - At the front desk, Megan scheduled the follow up meeting on 151110
041123 - 1330.
041124 -
041125 -
041126 -
041127 -
041128 -
041129 -
041130 -
041131 -
0412 -