My arm hurts! I had another surgery today...and I have a question?

  1. About ten years ago I burned my elbow using a heating pad. The doctors said it caused a bursitis. For years it would swell and then open and drain. (I have some trouble with my right hand since my accident when I was 13 months old)
    Anyways I couldn't find a doctor to help me with it... they said if they opened it up it would have a hard time healing. About two years ago when I was hospitalized for and operated on for an ulcer they also opened up my elbow. They would pack it and then when I went to live on my own a home health nurse came to visit. I was too weak to stay by myself so moved in with an old friend of the family and then the home health nurse stopped coming by.... I ran out of dressing supplies and would use whatever I could to try to keep it covered. Well after I came here Giuseppe started doing a different treatment on it and it started to heal some but not all the way. He got me in to see a doctor about the treatment we were doing and the doctor said I could have it surgically closed. They scraped the inside of it to get rid of skin cells that had migrated inside the wound and then sutured it shut. Well it opened back up but not as bad. So they did it again, then it reopened so the next time they went in and reopened it and did a zig zag incision. It looked pretty good but they said not to wheel myself but I had to for school and then it reopened in a small place. Today they re-sutured that area.
    They said there was some clear/blood tinged fluid and that is what use to happen. They were not sure if my arm would continue to produce the fluid or not and if it does continue to produce the fluid then ???????
    What do you guys think?
    I'm not supposed to do ANYTHING with my arm for at least 2 weeks! Including transfering, wheeling etc... and I have to wear a splint again to keep my arm straight.
    What do you guys think?
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  2. 14 Comments

  3. by   CashewLPN
    joe--

    hmm.... for now, to aid the healing process.... keep your arm straight, warm and dry....
    (bent, over warm and damp is the breeding grounds for infection)
    if you stress the healing lines-- they'll get more scar tissue, and heal less properly.... you definately dont want that...
    hmmm.... perhaps if you keep getting the bursa fluid forming, maybe they'll have to drain it periodically.... but, it'd be better than an open wound any day....
    Feel better....
    if this didnt make much sence, Its because I'm exhausted.... had a way busy shift...
    (Wasting away again in dementiaville)

    Be Good!
    --Barbara
  4. by   nursegoodguy
    Yetti you did a Great job answering that!
    I'm really hoping this time he will heal completely up!
    This is the fifth operation he's had!
    I think it would have the last time but... I requested someone go with him to school and push him to his class but... SUITS... need I say more?
  5. by   l.rae
    Joe, hope you are feeling better by now. Please try to not use that arm for 2 weeks, Is there any kind of handicap services at the school where y ou go?..Maybe someone would just volunteer to wheel you to and from class, it is such a short time. good luck.....LR
  6. by   SmilingBluEyes
    May this be the LAST operation you have. Here's to rapid and complete healing!
  7. by   rncountry
    I'm going to address this to both Guiseppe and Joe. I am a wound nurse, I deal with all sorts of very nasty wounds, and have been doing it for years. Many times it is best to allow the wound to heal without it being surgically closed. I wonder has anyone ever tried a wound vac on this? It works wonders.
    Guiseppe is it possible for you to email me a picture of the wound? I would be most interested in looking at it because it is very difficult to know what is a good tx without that. More often than I care to think about the docs do not know good wound treatments. It may be something that can't have a whole lot done with it right now, but I'd be interested in seeing. I'm also wondering what type of school Joe is in, they may be legally required to provide what he needs to get to and from class so that the arm can be healed appropriately. I know in Michigan that is the case anyway.
    If a picture can be emailed send it to activistrn@yahoo.com The vast majority of the wounds I deal with are long term nonhealing wounds, and not to brag but I heal about 90% of them before my patients go home. It is most certainly more difficult to make recommendations without actually looking at the wound, but I would like to give it a shot.
  8. by   nursegoodguy
    Wow Rncountry, I am impressed!
    The wound has now been surgically closed though. So I am just hoping it will stay uncomplicated and healed!
  9. by   CashewLPN


    Hey Joe-- You'll be ok... just follow directions, and you'll be fine...

    hehe

    Wishing you the best
    -Barbara
  10. by   NRSKarenRN
    Dear Joseph:

    Offering you some words of advice. You've stated this is a re-occurring wound that has been surgically closed before. I believe you are wheelchair (WC) bound (correct me if wrong) so these are things I would be concerned about. Will defer any talk about wound care now since you had surgery and have wound care orders

    Pressure ulcers develop from prolonged pressure on body area, shearing forces (rubbing or dragging skin against fabric/mattress/ wheelchair arms), poor nutrition, circulation problems and in persons predisposed to diabetes. Healed skin is different than regular skin in that it doesn't have the same elasticity so it doesn't stretch as easily and can develop thickness which rubs underling skin layers.

    Things you can do to help yourself:

    1. Pressure Reduction and elimination of shearing forces:
    Suspect you spend a good deal of time in Wheelchair. I would make sure you had extra foam padding on armrests covered with sheepskin pad to add extra cushioning. Persons in whelchairs tend to sit with their arms bent at 45 degree angle for hours without moving arm. I would suggest you dangle your arm every 30 min-1 hour (every time TV show changes/end of meal) to decrease tension on elbow incision once splint removed and remember to do this for rest of your life. Don't know if you wear an elbow protector but would do this for at least first three months post surgery.
    Example of protector:
    http://www.allegromedical.com/Home/m...15528&P=174294

    Proper body mechanics is important---has physical therapy evaluated you to make sure you have good positioning while sitting?

    2. Nutrition

    4th Basic Principle - Provide Substrates for Healing

    Protein & Caloric Needs with Chronic Wounds
    Protein Requirements = 1.25->1.5 Grams of protein per kg of body weight per day
    Caloric Requirements = 30 - 35 calories per kg of body weight per day. If the person is unable maintain an adequate food intake high nutritient supplements should be used to meet the nutritional needs.

    Necessary Vitamin and Mineral Supplementation & Wound Healing
    Vitamin A -> Multivitamin daily
    B Vitamins -> Multivitamin daily
    Vitamin C -> Multivitamin daily
    Zinc -> 220 mg/ day in presence of deficiency
    Iron -> Supplement only if no active infection

    From: Chronic Wound Healing by Rita A. Frantz PhD RN FAAN
    www.nursing.uiowa.edu/sites/chronicwound/


    What this means is that you should eat an extra serving of meat/fish/chicken/egg/cheese each day--size of deck of cards and drink carton of milk. Even peanut butter sandwich at bedtime helpful---in addition to three meals daily. Include carrots/yams/sweetpotatoes/orange juice (Vit A + C), green leafy vegetables/brocolli/enriched bread-Rye , Wheat etc (Vitamin B), Liver and raisins/dates (Iron) in your diet.

    Most wound care doctors in my area have patient take a Multivitamin with Zinc daily. Some are using the supplement L Arginine too.

    My Dad had a bloodclot in his leg this year post surgery resulting in a black toe--doctors thought he would loose it. I had him drink Resource type supplement called Arginaid (has L-argine in it)---was able to get trial case for free. Along with good nursing and wound care, He was healed in 10 weeks! Ask the Dietician at your facility if this would help you.
    http://www.novartisnutrition.com/us/...eDetail?id=288
    Arginaid: http://www.novartisnutrition.com/us/...source=summary

    Good Luck and Good healing!
  11. by   nursegoodguy
    You guys need to just quit your current jobs and come work with me and baby face joey!
  12. by   adrienurse
    Joey. Heal fast. heal well.
  13. by   1HonoraryNurse
    You guys are the best!
    Thank you for all the GREAT advice and YES I will do all you have advised!
    I'm just hoping that this will be the last time I have to have it operated on...
    Thank you guys again!
    And I agree with Giuseppe... Please come to New Mexico and work with us!!!!!!! We'd be like one big HAPPY family!
  14. by   plumrn
    rncountry and NRSKarenRN I'm very impressed! Wound care decisions seem to be one of the hardest things for most nurses to become adept at. So many wounds... so many treatments!
    Nice to know we have someone to consult if the need arises!

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