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Julia Kizhner
Julia Kizhner, Physician Assistant
Category: Health
Satisfied Customers: 1126
Experience:  7 years experience working in Primary Care as well as Gastroenterology, Sleep Medicine & Weight Loss
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Julia Only..........I have a question about Hospice. My uncle

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Julia Only..........I have a question about Hospice. My uncle decided to get my aunt Hospice care, out of the blue. She isn't worse, she has remain the same for quite awhile. I have always thought of Hospice as end of life. I read online this tonight. Hospice care is appropriate when a patient has a terminal illness with a life-expectancy of six months or less. When reading this I got upset of course seeing this only six months or less. Has Hospice changed at all, in regards XXXXX XXXXX taking those kind of patients with a few months? Because I certainly don't feel that she only has a few months to live, I feel it's a lot more.
Submitted: 3 years ago.
Category: Health
Expert:  Julia Kizhner replied 3 years ago.

Good morning Beth,

 

Technically what you read is correct. Hospice care is meant for someone who has 6-12 months or less of life expectancy. During hospice care nothing aggressive is done to save a life (for example, defibrillator is not used if heart stops or no surgery is done if someone is having a heart attack) and all care in hospice is palliative which basically means that a patient is made comfortable and the pain level is satisfactory treated.

 

Now, having said this I want to add that not all patients who are started in hospice have 6-12 months of life expectancy. As a matter of fact, I know patients who have been in hospice for 2 years and finally were discharged because they were doing fine. Recently I met a patient who was in hospice for 14 months after chemotherapy for his cancer was stopped and all of a sudden, his body on its own put cancer in remission and he started getting better. As far as I am concerned, it was a miracle but yet, he left hospice after 14 months and moved from New York to Chicago.

 

I was surprised to hear that your aunt is now in hospice when you mentioned it recently since it sounds that she is doing fairly well and since you take such great care of her.

 

I don't think you should get prematurely upset. Hospice is not a death-sentence and I think if everything holds stable with your aunt, she will be just fine.

Customer: replied 3 years ago.
Thank you Julia, I ask my uncle why he wanted Hospice & he said someone mention to him that they receieved great care for their dad. He agrees with me that my aunt is healthy other than the dementia. I want to show you her blood blister on her foot, to me it looks like it's spreading. The nurse said today it will eventually burst on it's own, I keep it covered, with my aunt the way she moves her feet around I am shocked it hasn't burst yet. Can blisters be serious or just eventually disappear? I have had blisters, but never a blood blister, and mine burst like on the hand or heel of my foot. I have never seen one this bad.graphic
Expert:  Julia Kizhner replied 3 years ago.

Beth, the picture is very blurry and when I open it, I cannot see anything at all. Can you, maybe, retake it? Maybe from a bit of a distance? Take a couple of different ones.

Blisters should not be serious and they do disappear. Its just that I cannot tell at all if this is even a blister.

Usually patients with dementia are not put on hospice care because their prognosis is not predictable. The disease can be progressing very slow. Really, the only difference between hospice and not hospice is that no aggressive measures are taken to save someones life. Basically the life of a hospice patient is simply made comfortable.

Customer: replied 3 years ago.
Well she is sleeping right now & I have it bandanged, so later tonight I will send another one. In the meantime, my aunt gets these places on her legs when she lays on the pressure mattress or has a pillow between her legs one place will be flat & everything goes to one place like a huge lump, then when she moves around it goes back to normal. Like fluid builds or something making impressions in her leg & then moving to make a huge lump. That's the best I can describe it, I was wondering if that is normal? Also they aren't taking out her stitches til Monday or Tuesday & that will make the 14th day or 15th. I am a bit annoyed at that when the ER instructions say they should be removed by the 10th day. I worry they won't be able to get them out easily.
Expert:  Julia Kizhner replied 3 years ago.

Ok, when you are taking a picture, take it a bit at a distance. That will give better focus.

Take several shots at different distances, this will be helpful in case some will be blurry.

It is normal to leave stiches for 14 days especially on the leg. You don't have to worry, it will not be a problem removing them. It is also not painful at all. It is better to leave them for that long because your aunt' skin is very frail, this gives it more time to come back together. We take the stiches on the face off in 5-7 days because longer period of time will cause cosmetic problems but I don't think cosmetic problem is anything your aunt will worry about so it is safe to keep the stiches on for 14 days.

I am not sure if I understand what's going on with the swelling in the leg...is it in both legs? Is it just at the bottom or does this go all the way to the thigh? When she is up during the day, does she have any swelling in her ankles (like when you press on her ankle, is their an indentation mark?).

Expert:  Julia Kizhner replied 3 years ago.

Ok, when you are taking a picture, take it a bit at a distance. That will
give better focus.

Take several shots at different distances, this will be helpful in case some
will be blurry.


It is normal to leave stitches for 14 days especially on the leg. You don't
have to worry, it will not be a problem removing them. It is also not painful at
all. It is better to leave them for that long because your aunt' skin is very
frail, this gives it more time to come back together. We take the stitches on the
face off in 5-7 days because longer period of time will cause cosmetic problems
but I don't think cosmetic problem is anything your aunt will worry about so it
is safe to keep the stitches on for 14 days.

I am not sure if I understand what's going on with the swelling in the
leg...is it in both legs? Is it just at the bottom or does this go all the way
to the thigh? When she is up during the day, does she have any swelling in her
ankles (like when you press on her ankle, is their an indentation mark?).

Customer: replied 3 years ago.
The stitches are on her left foot. I haven't taken pics yet she has been sleeping, will try tomorrow. My aunts left foot same one she hurt does swell around the ankle more since this happen. But also what I am talking about is when she is lying on pillows or whatever they will make an indentation mark in her skin, but also fluid or whatever will form a big lump, then it goes back own when her legs are moved etc. That is the best way I can describe it. This happens in the lower part of her legs mostly. It's like how you have a piece of play doe & you make an impression, but like I said under the skin below the indent will form a huge lump or ball till the pillow whatever is removed like fluid.
Expert:  Julia Kizhner replied 3 years ago.

For some reason I thought the stitches were on the lower part of the leg. But, in any case, it is normal to leave them for 14 days.

I think I understand the issue with the swelling. She probably has some fluid retention in her legs due to her immobilization. Most people who are bed-ridden or wheel-chair confined will have swelling in the lower extremities due to immobility so when something presses on her legs or when she turns a certain way and stays in that position for a while, due to gravity, fluid accumulates. This is not necessarily normal but yet expected for someone who is immobile.

Customer: replied 3 years ago.
Is there any danger to the fluid accumulation? The blister burst today, some blood came out, I forgot to take a picture, before I put the pressure bandage on it. The nurse may come tomorrow to take out the stitches I hope, but if not Tuesday she said! I just cleaned it up & put on that WBG, so hopefully it will heal now!
Expert:  Julia Kizhner replied 3 years ago.

There is no danger of fluid accumulation with your aunt. It is almost expected that she has some.

 

I am glad blister has burst. Sorry I didn't get a chance to see it but I am glad its gone. It will take about a week before its nicely scabbed over, then its just a matter of time before the scab goes away. Keep the scab covered so your aunt doesn't pick it off.

 

Stitches removal should go very smoothly. Its a simple task even if 2 weeks later :)

Customer: replied 3 years ago.
Hi Julia, well the stitches took awhile to get out, it was uncomforatble, I had to hold my aunts leg I was afraid she would kick the nurse it was unpleasant I am sure. Anyway it doesn't look that great it still looks gappy. She didn't put any of the steri-strips on which I hoped she would for this reason. I cleanted it & put on WBG & she covered it really well. Is that normal not to be really well closed? I am scared it will get torn open again. It was bleeing some & so was the blister. I thought for certain the skin would be better closed as it looked well with the stitches like it was completely closed. What happens if it doesn't close all the way? I don't understand either why that foot stays swollen so much her ankle & toes. Before they would swell some hanging down, but since this happen it stays swollen all the time unless I have it elevated, is that normal also for this type of injury?
Expert:  Julia Kizhner replied 3 years ago.

Yes, it is normal not to be 100% closed. A lot of the wound is healing from the inside out. As long as the skin is not coming apart, there is no concern. If the skin comes apart, your aunt will need steri-strips. I am not sure as to why they weren't put in in the first place. Little bleeding can happen when the stitches are removed.

 

Yes, swelling is very very normal after this type of injury. She still has a lot of fluid that was gravitated down into her foot and it takes a while before it gets all reabsorbed. Some of that fluid is blood, some of it is just normal tissue fluid that was released due to the cut. I would expect at least a month or longer before swelling starts to go down. No reason to panic over the swelling.

 

Keep the wound covered and it shouldn't come apart. But if you start to notice it, call the nurse right away for her to come in to put steri-strips. If you think you will be too worried about it, her call her back today and ask her to put them on. There is absolutely no harm in putting them on. The reason the nurse didn't put them on is probably because she thought the wound has closed nicely.

Customer: replied 3 years ago.
No she thought it looked separated just like me, but she didn't seem concerned, she said she didn't have any of the strips with her, just to watch it. I think she should have been prepared since my aunt has thin skin. Well it doesn't look closed it looks separated, along the whole thing. She has it covered now so I don't want to take off the bandage or I would take a picture. She said she would call the Dr. but I know him he won't do a thing unless I call & bug him about it. She isn't coming back this week. Her other nurse that visits separate from Hospice will be here Wed. so she will look at it. I called one of her other nurses also not with Hospice & she said we can buy the strips, but she said using the WBG should close it. I just know that with my aunts skin the way it is, it won't take much too come apart.
Expert:  Julia Kizhner replied 3 years ago.

I don't think using WBG will make the wound close if it not well healed. Steri-strips are applied to hold skin together and will stay on for a couple of weeks. This will help the skin come and stay together.

I am sorry, but I don't know what else to say. There are wounds that sometimes are not even sutured (I had a patient who fell and tore his entire forearm; because his skin was so frail, he did not have any sutures so it took several months but the wound healed from inside out and he did well).

If the wound is not completely closed, I think it would be more important putting on topical antibiotic first (to prevent infection) followed by wound-be-gone. WBG has no antibiotics in it.

Try to take a picture of the wound to show me so that I can determine if its ok looking or not.

Customer: replied 3 years ago.
I called Hospice they said that it needs to air out & close inside out, they still don't act like they want to put on the strips. The WBG is for wounds with stitches, if you look on the website you will see how it heals wounds with stitches. The wound care Dr. said this is the best stuff I could put on any wound. It healed her scalp after everything else failed, so I will stick with it, I just ordered a huge tube tonight, it is very expensive, I should buy stock. I took a picture, before my cell camera died, I hope you can see it. I needed to put her to bed & wrap again so I hurried & took a quick one. I could see the other one clear, but you couldn't. The blister burst & it bleed, but now underneath it's black I am hoping it's just blood. It looks like an eye. I also wanted to say I appreciate all the times you have answered my questions, I know at times I can be repetitive, I'm just that way I need to be sure about things. If you would rather I just ask my questions open to anyone it would be okay just tell me, it's no problem. Like I said you've been great in helping me all this time!graphic
Expert:  Julia Kizhner replied 3 years ago.

I can see picture much better now although when I blow it up, it gets blurry.

 

Surprisingly the wound looks good. It is actually closed. There are areas where the skin seems to be slightly apart (especially at the top part of the picture) but under it, it is actually closed. I don't think this should come apart at all. Putting steri-strips will not even be beneficial here. I don't think you need to keep this wound closed. It looks perfectly healthy with no sign of infection. I imagined something much worse from what you were describing :)

 

The black part under the blister is blood. If you want, you can put warm compresses to it to try and dissolve the blood, otherwise give it time and let it dissipate on its own.

 

I should have clarified about the antibiotics and WBG - I meant that you should use antibiotics first and then put WBG, however, looking at the picture I can tell you that you do not need antibiotics. WBG is enough. Wound looks good!!

 

I don't mind answering your questions at all. As a matter of fact I always look forward to hearing from you :) Its just sometimes I feel as if I am not explaining myself well and get upset with myself. Because I couldn't see the wound and couldn't really tell you much, I felt bad that I had nothing else to add as a recommendation. That's all. You cannot imagine how much I appreciate you always accepting my answers :)

Julia Kizhner, Physician Assistant
Category: Health
Satisfied Customers: 1126
Experience: 7 years experience working in Primary Care as well as Gastroenterology, Sleep Medicine & Weight Loss
Julia Kizhner and 8 other Health Specialists are ready to help you
Customer: replied 3 years ago.
Hi Julia, The wound looks very good today, the skin looks more together. The blister is even looking better. I am only going to unwrap it once a day now & use the WBG. I think just leaving it be now will help, I put on the WBG this morning, there is no bleeding now, just the dried blood. Usually if I apply WBG & leave it until the next day it heals much faster. It says you can use it every 12 hours or once a day.

Now I want you to know that I truly appreciate all the time you spend with me on these questions, I just didn't want to wear out my welcome so to speak. Like I said I know I sound repetitive at times, I am a born worry-wart. No changing me now lol! You always explain things just fine, sometimes when I haven't slept well it takes me awhile to put things together, even sometimes when I have slept. I'm a little slow on the uptake as they say! :)
Expert:  Julia Kizhner replied 3 years ago.

I am so glad to hear the wound is looking better today. It honestly didn't look bad last night, judging on the picture. The wound will be just fine. You are doing everything right.

 

You will never wear out your welcome. I love medicine, I love helping people and it is very important for me that people understand the health issues. I always spend at least 30 minutes with each of my patient to explain them how medications work, why they take it, etc. Some care, some don't but I still do it :) You are not slow on the uptake, you just want to understand everything and I think you are doing a fine job on that. I've never met a better caretaker then you are. Your aunt is just lucky.

Julia Kizhner, Physician Assistant
Category: Health
Satisfied Customers: 1126
Experience: 7 years experience working in Primary Care as well as Gastroenterology, Sleep Medicine & Weight Loss
Julia Kizhner and 8 other Health Specialists are ready to help you

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