The Wound Vac

As most of you know, Frank has been dealing with a severe pressure sore since the first of August, 2022. He had surgery in September and has been on a wound vac since then. A wound vac is a device that decreases air pressure on the wound to assist in healing. We have been making slow progress and were quite pleased with the last visit to the wound care center. The doctor says he feels confident we can heal this wound without flap surgery. Frank and I had already decided that we would never agree to flap surgery which requires 30 days in a hospital setting with him lying flat on his stomach. NO WAY! Whatever it takes, we’re doing this at home.

Well, everything was going well until this past Monday. The home health care nurses came to change the wound dressing and noticed something unusual in the wound bed. It looked like a piece of black Granufoam dressing (the product they pack in the wound), but the nurse could not remove it. She insisted we make an appointment to see the doctor the next day and even waited while I called the clinic to make the appointment.

Everything Looks Great — or Does It?

Frank’s usual doctor – Dr. Fried – was out of the office that day, so we saw Dr. Hopkins, another highly recommended doctor. Dr. Hopkins could find nothing unusual. I had visually seen the wound the day before, so I took a good long look myself. There was nothing there! The doctor said the wound looked great and made one change in the wound vac setting, moving it from continuous to intermittent pressure. He explained that the wound could heal more quickly on the intermittent setting. They rarely use the intermittent setting because it can be painful, but Frank has no feeling in that area of his body, so it would be a safe and potentially positive change. The rest of the appointment went as usual. The wound care nurse applied a new dressing to the wound, and we went home.

Later that night, I noticed a bright red rash on Frank’s butt cheek near the wound. He said he felt fine, and his vitals were normal. I was confused about the redness but not alarmed.

Wednesday morning, the rash had spread, but Frank still said he felt fine. The home health nurse was due to visit the next day, so we decided to wait and see.

At 5:00 pm, Frank was in the den working on his computer. I went in to check on him, and he was very cold, shivering, and clammy, but his temperature was still normal.

“Frank, why didn’t you tell me you were cold? I would have covered you with a blanket or put a space heater in the room.”

Due to the spinal cord injury, his body does not regulate internal temperature normally, and external temperatures will affect his body temperature. We keep the house at a temperature of 73-74 degrees in the winter, but sometimes that isn’t enough for him. Frank will be bundled up with a hat and scarf while I run around barefooted in my shorts. It’s crazy.

“I’m okay.” He insisted as he shivered, “Just get me in bed, and I’ll feel better.”

Quickly, I transferred him from his wheelchair to the bed and covered him up with heavy blankets. This kind of thing had happened before. Normally it would pass as he slowly warmed up, but that was not the case today.

Things Get Worse

By 7:30 pm, Frank was feeling very poorly. Covered up with four heavy blankets in a 74-degree room, he was still shivering, now nauseous, and slightly lethargic.  His temperature and blood pressure were still normal, but he felt terrible.

“Frank, this is not good. Shivering, feeling cold, and clammy skin are all signs of sepsis. We may have to get help. Maybe I should call 911.”

Despite his condition, he still wanted to argue. “No. Don’t call 911. This has happened before.” It had. “I’ll be fine. If it’s my time to go, I’d rather do it at home.”

“Well, I can’t let that happen!” I reached for my phone.

“Don’t call. You know how expensive an ambulance ride is!”

I started scrolling through my contacts. “I’m texting Denise. I need her support.”

Denise is Frank’s primary home health nurse. After I explained what was going on, she suggested I call Dispatch Health to come out. Dispatch Health is a Mobile Urgent Care created to help patients avoid visits to the emergency room. They can check urine, draw blood, order medications, etc. It was 8:00 pm when I called. They stop service at 10:00 pm.

“I’m calling Dispatch Health, Frank.”

With closed eyes, he said, “Don’t call Dispatch Health. We’ve been through this before. I’ll be fine.”

“You’re not fine, Frank. It’s either Dispatch Health or 911.” He was silent.

“Hello, my name is Micki LaVres. I’m calling regarding my husband, Frank LaVres. We need someone to come to see him.”

“What’s your zip code, please.”

“66227.” I paced the floor, waiting.

“I’m sorry. We don’t service your area.”

“Yes, you do!” I replied quickly. “You’ve been here before!”

“Let me check that zip code again. What was it?

Slowly and firmly, I responded, “6.6.2.2.7.”

I heard mumbling, then, “I’m sorry, but according to your zip code, we don’t service your area.”

I felt like screaming at her, but I managed to sound calm. “YES, you do! I have the folder they gave me from the last visit in my hand!”

“I’ll check again with your street address.” I heard more mumbling. “Oh yes, ma’am. I see you now.”

Thank God, woman. You need to stop doing drugs at work.

“I’m sorry, ma’am, we don’t have any availability now.”

“What do you mean you don’t have any availability now? I thought you were available until 10:00 pm?”

“Yes, ma’am, we are, but we have no availability until tomorrow.”

What the fuck!

“Well, thanks for nothing,” I hung up.

Calling My Backup

I texted back to Denise and explained what had happened with Dispatch Health. Both of us were frustrated, but not giving up, we devised a plan: push fluids and hold some urine for her in the morning for urinalysis. I would continue to watch for further signs of Sepsis; high heart rate, low blood pressure, confusion, or any signs of Autonomic Dysreflexia; high blood pressure, headache, and blurry vision. In either case, be ready to call 911.

I slept very little that night. I don’t think Frank slept at all. At 2:30 am, when I checked his temperature, it was 101.6, so I gave him two Tylenol tablets. I would have preferred Ibuprofen, but what I had was expired. His temperature hovered around the same for the rest of the night. The rash had spread considerably, a bright red area from his hip to his thigh.

The home health nurses arrived at 9:30 am. I was so glad to see them. Frank’s temperature was 101.4, and his blood pressure had dropped to 84/62. That blood pressure for most people would be very alarming, but for Frank, it’s not much below his normal – spinal cord injuries suck – but based on his BP, the nurses recommended he go to the emergency room.

Without hesitation, Frank flat-out refused. “I was just at the doctor's Tuesday! I’m not going anywhere.” He was adamant. It was a relief to have two nurses there to help. He is a stubborn man.

Denise remained calm. “Okay. Let me see if Doctor Fried will help us over the phone.”

These amazing nurses and his doctor swiftly took care of everything so Frank would not have to leave the comfort of his bed. Dr. Fried, an infectious disease specialist, ordered a barrage of tests: blood cultures, urinalysis, wound culture, and a whole bunch of other stuff that I can’t remember. The nurses had to run to the local hospital laboratory to pick up the necessary supplies and did everything right at home. They used four large collection tubes for the blood cultures and eight small tubes for the others, in addition to a swab tube for the wound culture. They did everything the Emergency Room would have performed right at home. I almost cry just thinking of their concern, professionalism, and ability to perform swiftly under such stressful circumstances. They went above and beyond. It’s truly heartwarming. I have tears in my eyes thinking about it.

Doctor Fried ordered antibiotics while waiting for the lab results; Cephalexin 500 mg 4 times daily. Strong stuff, but he knows his business. This would be the second time Dr. Fried was instrumental in saving Frank’s life.

Infection

The lab results came in. Everything was in the normal range except for one thing. The wound culture showed Strep! WHAT! I thought strep was only in your throat and transmitted by direct contact, but apparently not. After researching, I found information supporting the possibility of Strep lying dormant in your body and reemerging when your immune system is compromised. Dr. Fried’s theory is that changing the wound vac setting from continuous to intermittent pressure may have allowed a bacterium to form. We’ll never know for sure.

In conclusion, I’m happy to share that Frank has recovered from whatever IT was and is feeling well.  We are together to share another day. I honestly don’t know why things happen the way they do, but I do know this; I’m grateful for the help when I needed it. And Frank – well, he’s just happy he didn’t have to go anywhere!