Week 3

Hello again!

This week I had four half days with Dr. Stein and Dr. Weiland, as opposed to only two last week.  This means I saw twice the patients, and, therefore, twice the wounds.

Like I mentioned last week, most of the patients are either very old and/or diabetic.  When I say old, I mean really old.  For example, this past week, over 75% of the patients were 85 years old or older.  Age plays a role in the rate wounds heal: the older you get, the more likely you'll have to go see the nice people at Osborn Wound Clinic.

Most of the patients with more severe wounds have to come in weekly to see how they're healing.  Since I came in last Wednesday and Thursday, I was able to see how some of the same patients were progressing with their wounds.  Some of the wounds drastically improved: a patient came in 2/last week with a wound resulting from running his leg into a table (trauma).  I saw him again on Thursday (2/25), and his wound looked a lot better.  Some of the other wounds I saw, however, looked exactly the same.  The patients whose wounds looked worse resulted from them not following the doctors' orders (keeping their leg elevated, wearing a compression sock to reduce swelling, etc), and I learned that possibly the most important thing to do in order to heal is to listen to what your doctor tells you.

Many of the wounds I saw involved hematomas, pictured below:

A hematoma is defined as a localized collection of blood outside of the blood vessels (basically a big bruise).  The elderly can easily get a hematoma because of the thinness of their skin, but a patient who is taking blood thinners can also quickly get a hematoma because of the rate they bleed.  

Many of the patients are interesting as well.  Before I started my rotation, I assumed most patients followed the doctor's orders.  However, I quickly learned this week that this is not the case.  If a doctor prescribed elevation or a compression sock, many of the patients were non-compliant, which surprised me.  And this is why, in many cases, the wounds did not heal.  

Finally, one of the most interesting things I saw this week was a picc line being removed.  A picc line is basically a long lasting IV which is inserted in the arm and goes through a small vein towards the large arteries near the heart.  You can run medication through these for fast-acting results, and its good for patients who need a lot of medication because you can leave it in for a couple weeks.

That's all for this week, folks! Stay tuned for next week for more wound updates!