This lady has just left the clinic room and has me stumped....
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Female 74yrs
Dx Parkinsons
Lymphoedema affecting left leg (has comp bandaging)
Pt reports no other significant Hx.
She presented for assessment nearly 8 weeks ago with painful apical lesions on the R4 and R5 digits. These were massively, grossly overgrown HD's mixed into OG nails and relly quite painful to touch.
The massive problem here is the tremor. On touching the areas her feet just go wild and rotate all over the place, you cannot physically restrain them either and I'm a big strong bloke!
So I sent her on her way and contacted the GP; we arranged for her to cluster her Parkinsons meds in the late evening and early morning just prior to treatment and went to see her at home thinking it might be a more relaxed setting. Same thing, I just couldn't do anything without fear of stabbing her or myself with the scalpel.
So I went on my way. A week or so later we got back to clinic and used the podospray drill and with help from a colleague managed to get the lesions debrided and dressed reasonably well. This was 4 weeks ago.
She came back in today with the same dressings on, she was told to remove them after 5 days. Her right foot is grossly oedematous, red, hot and has a tracking infection on the dorsum, going into the leg, not good.
Managed, after much messing about, to get her a course of antibiotics (not from her GP, from a random passing one, long story). So I'm about to sit down and write to the GP again. Asking them to see her as an urgent case and explaining that we just can't do anything for this lady due to her tremors.
This lady is a little incoherent, no family, seems to have no idea what meds she is on and when to take them, this has all been made clear to the GP.
Long story that......:)
Anyone have any hints, tips or experiences with similar patients. What did you do, what should I do????
ps apologies for bad grammar and spelling, I fired this out between pt's.
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