Today, at his office in St. John's Town Center, Dr. Swain declared my foot ulcer closed. It was first discovered June 15, 2013 after midnight. Earlier that day, I had assisted a employee of Brooks company with a 'valet' garbage pick up. I had done this with the guy 7 times over the prior 11 days.
One pair of sneakers completely gave out. The process included running up and down stairs of 10 buildings, each with two unconnected landings, for a total of 20 trips up and 20 trips down. 280 trips on the stairs at 313lbs over 11 days.
Thus began my journey in foot care & wound care. They are not the same, as I would find out.
I tried putting Neosporin in the wound and covering it with a band aid. It was recommended that I soak the foot in Epsom Salt (by my Mom). After a couple of weeks doing this, and it NOT getting better, I called a foot doc that had some surgery on my angle in October the year before. The first avail appt was 9/5.
Sept-Dec, I was under the DPM care, which involved a bi-weekly visit to one of his offices for a debridement. I also had a home health nurse visiting 3xs a week. During this time I had a lot of exudate discharging from the wound. I was fitted with a wound vac; but the treating nurse did not accurately follow the wound vac protocol, which included putting foam between my foot and the hard plastic basket. The result: The wound got significantly worse. I finally asked the DPM to discontinue the wound vac. He agreed and said he would enroll me in a study he was conducting instead.
In January, I entered a foot study he was conducting. It involved receiving (or not, if in the control) ultrasonic waves, with the thought that they would promote healing.
At first, the wound improved greatly. The visits were basically 2xs a week, and each time I would get the debridement, then the protocol.
After that, the visits were once a week, and the protocol applications were even more spread out. The DPM discussed with me the possibility of osteomyelitis being present, and that this could involve the removal of the outer 1/3 of my left foot (4 & 5th metatarsals).
The study ended, and from May-July, the DPM kept pushing the idea of osteomyelitis. On June 17, he had me go to the emergency room of St. Vincent's, with the intent of being admitted and him performing surgery. The ER doc did not agree with the idea that the osteomyelitis had progressed to the degree that the foot required major surgery. I was discharged.
The DPM opinion and the ER doc opinion were both based on X-Rays; the DPM (or his office) did not want to do the work required to get an MRI, necessary for an actual conclusion. It was then that I determined I needed a new doc, or at least a second opinion.
I called the ins, and requested that they give me a wound center to go to. In the 2000's, I had a wound on my leg that was successfully treated. The provided me with one: Memorial Wound Care.
The first avail appt was 8/19. So I continued seeing the DPM through June, July and Aug. The DPM finally got the MRI ordered for Aug 15. I had the MRI done, they told me the results would be avail 8/20. I went to the wound center 8/19. I saw Dr. Swain for the first time. He immediately had a plan: at the first sign of infection, he would remove a piece of bone from my 5th metatarsal.
I went to the wound care center 2xs a week, from 8/19-11/6. One day was a doc visit, the other was for the nurses to change the dressing. During the nurse visit on 11/6, the head nurse, Lu (for Lucinda), called the doc. The foot had suffered a blow out indicative of infection. Dr Swain came to the wound center, inspected the wound, then made some calls. Next, I was admitted to the hospital for a metatarsal resection.
I was in the Hosp from 11/6-11/10. On 11/7, Dr. Swain, DPM, performed successful surgery. Why do I call it successful? In just over 60 days, he declared the wound closed!
After the surgery, visits to the wound care center were once a week through the end of the year. That was supplemented by a twice weekly home nurse visit. The nurses changed the dressing, just as was originally being done at the nurse visit at the wound care center.
He said that care would have to be taken over the next year; I would need special shoes & inserts. But no more wound dressing, no more home nurse visits, no more big procedure to prepare for a shower (the wound couldn't get wet).
Here is what the wound looks like today:
And a close up:
It looks like maybe there is still a scab. But if he says it is closed, I'm rejoicing!! 19 mos, almost to the day. But 5 mos to the day under this Doc's care, and 2 mos + a week after the surgery.
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