normal skin flora

[M Fowler]

The nurses were terrible just cramped it in there but the nursing aids were fantastic being careful to stay away from the tissue. Damn RNs.

[drhulsey]

....Damn RNs.

They just expect men to be as tough as women
Twice a day is usually plenty; once a day when it gets cleaner.
I have been taking care of wounds for about 35 years now, from infected cysts to abdominal wounds you could sit your child in
It's very time consuming for the patient. Patients have to have patience

[Andy Le Blanc]

I had a bad nurse the other day, slamming IV fluids into a patient who has been
on IV antibiotic for a long period, I had to have new IV put in 5x in a day and a half
after that , my veins were getting squirrelly. damn near negligent on her part.

Some things you cant do much about, you could stick your finger in the top of my hip,
packing that was bad no matter what.

Your right about child birth, dont know how my wife did it.

Some MD, RN, PA, have the nack for patient care, some not so much.
It also depends on the patient, I like to chat, get a relation ship going,
I don't expect perfection, that's a job I'd be hard pressed to do.
Patients in pain cant be fun for you guy's either.

[Structo]

I noticed that when my wife was in the hospital a couple years ago.

Most of the nurses were very nice and pleasant.
There was one male nurse (oxymoron?) who was terrible.
I got in an argument with him because her surgeon had left orders that she not be given any blood thinner type medications due to bleeding or bruising.
The male nurse was trying to give her a 800mg Motrin pill (ibuprofen).

I told him I thought that was classified as a blood thinner like aspirin was.
He kept trying to give it to my wife and when she said it was too big he was trying to break the pill in half. With no gloves on.....
In this day of staph infections and MERSA, you can't be too careful and this nurse was an idiot to begin with.

I told him to leave the room and went and talked to the head nurse.
She said, yes, he is a problem. But because of the union their hands were tied. I said I did not want him caring for my wife.
When the surgeon did his rounds I asked him about it and he confirmed that my wife was not to have any aspirin type drugs...
He went and straightened out the nurse and wrote on the chart in big capital letters, NO IBUPROFEN!

Yes, some nurses have no business in patient care, because they are terrible people to begin with.

Get well soon Andy. Just leave the politics at the door.

[CaseyJones]

The real moral of the story, as find myself catching up,as I'm discovering,
is that one should not post while in pain or on pain meds. Your not as rational as you think you are....

I'm never as rational as I think I am.

Weasels ripped my flesh. Owwwie oww oww oww.

The gland then fills itself up creating a cyst. These can be present for years causing no problems.

The good doctor gives us the technical lowdown with the best of intentions. Which of course is like being on another amp forum, "My tubes don't all light up the same. Does that mean something is wrong?"

Well, look at the bright side. You just earned The Ultimate Big Zit Merit Badge. Now you can go to Taco Bell and taunt the kid at the counter. "Hah! You call that a zit?!"

[drhulsey]

... You just earned The Ultimate Big Zit Merit Badge...

Casey, maybe we should start a Big Zit Forum

Some MD, RN, PA, have the nack for patient care, some not so much...

It's like any other profession, some are good at it, some aren't. Even those that are good at it have bad days. Every patient has a right to question every treatment and refuse if he/she wishes (notice my political correctness), and to cuss if it hurts

[Noel Grassy]

Glad to hear you've got that pernicious malignancy in remission. There's nothing worse than a health issue especially ones as threatening as infections.

Interesting about the wound wall being the "living cyst". It sounds like something I might like to will to my detractors.

Seriously though keep healing nicely as it sounds like your not quite out of the woods.

NG.

[Structo]

Reminds me of a guy I knew that was on my bowling team years ago.

He showed up one night with a big bandage on his right hand.

He had gotten bit by a Brown Recluse spider.

The venom causes the surrounding tissue to die.

By the time he got treatment for it, the hole was about the size of a half dollar and over 1/4" deep.
This was on the side, heel of his hand.
Black and nasty looking.
If I recall he had to have some skin grafting done as well.

He said he had been moving some firewood outside his house and never even felt the bite when it happened.
He didn't know what had bit him until he went to the doctor who recognized it as a Brown Recluse spider bite.

I never had even heard of that spider before and I also didn't know they were in my area. I had seen black widows but the recluse was a new one to me.

[Andy Le Blanc]

Those brown recluse are bad, I've seen some bad scars too.

Big zit fer sure, it got bad fast. Saved by antibiotic's
You could squeeze over there and it would come out over here.

My wife has been awesome, getting me around, tending the kids.
Got to pull the last of the packing yesterday. still up and down ,
maybe I'll have the energy to turn over a couple repairs tomorrow.

"living cyst" would be a good name for a band.

cyst-less in seattle.....

many thanks for the kind support

[drhulsey]

... He had gotten bit by a Brown Recluse spider...

I'll spare you the Brown Recluse lecture

[Noel Grassy]

That delightful skin irritation is called necropsy I believe. I'm not sure they can arrest it in all cases either.
Also known as the Fiddleback Spider and they aren't much bigger than a Quarter dollar. I've never seen one and have no idea what their web looks like. I wonder if it's as formidable a thread as the one a Black Widow poots forth. You can actually hear that shit when it snaps!

Doc I'd like to hear your Recluse rant! I'm weirdly in awe of the things that terrify me.

On a similar thread cloth was recently made from the collected silk of the Golden Orb spider. Although I believe it was successfully made a century ago by a Frenchman who died with his secret method.

NG.

[Noel Grassy]

Please see my short film titled Morsure d'araignée.
It might translate as "Tappin' the sap".
Warning! Heavyweight EWE! factor

The link is here:http://www.myspace.com/7204047

[drhulsey]

OK You asked for it
Black widow spider bites will make you sick, but the brown recluse bite will cause tissue necrosis (dead skin and fat). How much depends on how much venom is injected with the bite(s). Skin will be affected less than the fat underneath, but both can be lost in substantial amounts. There is no antidote to the venom, although some treat patients with Dapsone, a drug used to treat leprosy. People seldom come in immediately and seldom know what bit them. The wound is very distinctive, and not produced by anything other than Loxosceles reclusa in my neck of the woods. Years ago, most bites occurred when people were working outside around out-buildings and wood piles. Now, they're most everywhere. I've seen patients who got bitten putting on a pair of clean pants or crawling between the sheets to go to bed!
Mainly, we have to watch the wound over time to see how much skin and fat will be lost, then remove the dead tissue and graft skin. Early removal of the bite area has been tried, but usually results in taking to little or too much. It's best just to let the wound mature, then it's easy to tell what needs to go. Loss of skin and fat on the fingers, genitals, or face can require significant reconstructive surgery and result in deformity and loss of function Not all of them will need surgical treatment, undersoring why we watch and wait. Knowing when to operate depends on surgical judgment.
I don't recommend debriding the wound in your bathroom (unless you're Survivorman) but obviously that stuff has to come out. If not removed, it would eventually come out on its own unless the patient dies of secondary infection
Most of the brown recluse spiders I have seen were 1/2-5/8" diameter. The fiddle is very distinctive, almost photographic, but you have to get REAL close to see it. A plastic surgeon at Vanderbilt University used to send college students out at night into barns, etc., to collect them for the venom which was used for research purposes.

Please see my short film titled Morsure d'araignée...

Noel, I've seen a lot of things over my 35 years in surgery, but that may rank as one of the most disgusting things I have every seen

[Andy Le Blanc]

yummy.... and I like spiders

I think there's been some reports in Maine, but its a hard freeze in winter
and many specie cant cut it, but with the weather changing.....

[Noel Grassy]

Thank you Dr Hulsey for fleshing out the details of those spider bites. It would seem that the Recluse has a more antagonistic and perhaps vicious demeanor than any other arachnid. I mean you have to destroy the Black Widow's web to get it defensive enough to bite. Almost every spider would rather be a loner and just hang out in an area with little human traffic. I hear the Camel spider[not an arachnid BTW] enjoys the shade provided by a human. Even the big hairy tarantulas want little to do with their own kind let alone the human element.

I'm grateful to have never crossed paths with the Loxosceles reclusa.
Joining the 8 eyed Paganini on my list would have to be the Box Jellyfish in the Southern hemisphere. No bouts with necrosis but they inject a barely measurable dose of venom that becomes so painful that even after administering near fatal doses of opiates the victims writhe and scream from the unholy pain until their last breath. Mommy!

Finally, this insidious scourge must be exterminated at all costs!