Didn't get this updated after his appointments yesterday so will try to get the highlights from both days in today.

Dr. Hosenpud and Tina, the VAD nurse, are both concerned about Bill's leg. It is swelling some again and it isn't exactly bruised but it is discolored. He also has a bad pressure ulcer on his heel on the same leg. Dr. Hosenpud found that they had not done an ultrasound of his leg when he was at the er Saturday so he ordered one yesterday. It was negative for blood clots, so that is not the problem. We've asked about infections and they told us that since he is on Keflex already that would take care of any infection. But, it is going to hold his rehab back some.

We met with rehab today and again there was a lengthy discussion about his leg. It was not swollen this morning, but by the time of his appointment it was and it was warm to the touch, although the discoloration was not as dark as it had been. It was decided to have him see a wound specialist for the pressure ulcer along with a podiatrist and he is going to see physical therapy for his rehab instead of cardiac rehab. At least that's the plan for now. He was also told to keep his shoe off whenever he's not going to be walking and to keep the leg elevated with the heel hanging over the edge of the pillow.

Of course since they told him that he has done just the opposite, kept his shoe on with his legs crossed. When we were getting ready for his dressing change I took his shoe and sock off and the foot is really swollen again. So it's on a pillow and is probably uncomfortable. He was also complaining that he would have to sleep on his back.

I've decided tonight that I'm going to have to treat him as a child in some respects. He's not drinking enough, even being on the fluid restriction. This is keeping him too dry vascularly which in turn leads to the dizziness and nausea. I don't know if he thinks that he can't drink much because of the fluid restriction so he won't drink or what. But, I'm going to show him how many ounces it is. Tina even told him yesterday to drink more than the restriction even though he has some swelling in the legs. He needs it for the pump to work properly.

I'm also going to have to make him go to the bathroom whether he wants to or not. He went to the bathroom about 9 this morning and I had to tell him to go again at 9:30 tonight and he had not gone at all through the day. This is also contributing to the UTI. He keeps telling me that he doesn't have to go, but he goes when I tell him to. I think this is a result of having the catheter in for so long. It's still hard for his bladder to realize that it is full. (He would be horrified if he knew that I was writing this and I know that it is more info than most of you want to know. But it helps me collect my thoughts on things.)

His wound looked good tonight. The drainage was much less than it had been. The area that is still stitched is looking a little angry now and Tina and Lorraine went back and forth about taking the stitch out. The only reason the stitch is there is to keep the drive line from moving too much until the skin grows around it. It has closed on about 3/4 if the site, but one part is still open. But, if the stitch area gets too irritated it will have to come out. We're hoping it can wait until next Wednesday when he sees the nurses again.

So, that's it. The wrap-up for the past 2 days. We shall see what tomorrow brings as far as the foot goes.