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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.
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.
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?).
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.
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.
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 :)
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.
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.
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 :)
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.