Wise? Nurse? Peeps? Help!

[watchthisbaby]

I'm posting for a friend of mine who has a T9 sci. He's about 2 yrs post, and has major problems. I'm not sure I even know where to start, so I'll try to keep it simple and please feel free to ask me for more info if you need it. He's had a decubitis on each hip for well over a year, level 3 or 4. He got rid of the wound care nurse a long time ago, because there was no improvement. Also since he left rehab (right after his accident) the only Dr he has seen is his PCP, and done no additional therapy even at hm.

He's been in the hospital for the better part of 2 mo's now. He has MRSA really bad (idk if there is a scale for how bad or good it is),They also found 2 blood clots. He was just transfered to a nursing home to hopefully get the MRSA under control and get his protein levels up. Then send him to Harbor View in Seattle (great hospital to get your life saved @ and then get out quick, imo),and they are planning on removing the top part of his femur bones. Is this typical? he was told the hospital only does about 10 of these surgeries a year.

There is so much more, he doesn't take very good care of himself. I've asked him more than once if he's trying to kill himself!! He says no and I believe him, I think he's understanding my concern for him now.

Any advice on questions he should be asking, or things he should be doing?

[arndog]

My heart goes out to you and your friend. You are a very good friend to try to help him. Is he getting treatment for his depression?
There are a thousand things to address - nutrition, smoking, inactivity, where do you start?
Good luck, I am sure others will give ideas...
jon

[watchthisbaby]

arndog, thanks for the reply, and yes he is being treated for his depression. It's all just madness, idk what to say half the time. I told him he definately needs a second opinion so I'm calling my psyatrist (sp) tomorrow.

[SCI-Nurse]

Hi,

Your friend sounds like he's got alot going on.
My guess is that he is being sent to the Nursing home to build up his nutrition in general and more specifically prior to surgery. If he is not eating I suspect his nutrition level (albumin and prealbumin) are low, which is detrimental to both wound healing and operative status. Building him nutritionally is definitely necessary and beneficial.

Is he on a special bed surface (such as a clinitron) for wound healing.
Is he on blood thinners such as coumadin for treatment of his blood clots? This would definitely have to be under control prior to surgery.

First question is why they are suggesting removing the top of his femur bones?
Is this due to his hip decubiti ( which may have a bone infection with MRSA?) or is there some other orthopedic problem going on? This will help guide the questions he would ask.

AAD

[watchthisbaby]

Yes he is there to build up his nutrition, and is on 10mg of Coumadin (I think it's mg) and he said they are suppose to lower it to 8mg tomorrow. I know at home he has a rotating bed with a special mattress. I believe the MRSA is in his bones, so is that kind of operation typical?

[SCI-Nurse]

The coumadin is the treatment fo rthe blood clots.
CWO

[watchthisbaby]

I aplogize I guess I'm talking in circles and not making myself clear. I'm aware the coumadin is a blood thinner, but is that a normal dosage, and is the femur surgery typical?

[november]

There isn't really a normal dosage of coumadin. They monitor your pro-time and prescribe the dosage depending on how thick/thin your blood is. 10 mg seems high, but his blood must be thinning out so they are lowering the mgs. Make sure he monitors and tells the doctors all meds he is taking both rx and otc. Also certain things in your diet can affect how thick/thin your blood gets. A lot of interactions can happen with coumadin.

[SCI-Nurse]

Actually monitor PT & INR.!0 mg to start out with but needs to be checked frequently and adjusted.
CWO