Is there a doctor in the house?

[dragonfighter60]

I know there are a couple people in the medical field on the board so I will pose this question.

Is there a less painful way of removing bandages over surgery wounds other than just taking them off by ripping everything open again? (not stitched just the blod clots and the bandages are stuck to it horribly. Then when i take it off 1) it hurts A LOT and 2) it all starts gushing blood again.) I can't get it wet. Its my 2 big toes.

Also, I can't get ahold of my doc for tips from him. He just handed me a bunch of gauze and betadine and told me to change at least twice before I see him again on Monday<-- plus I was half out of it when he told me because the anesthetic hadn't fully worn off yet . I changed it once already and the pain was very bad as I ripped the original bandage off of the toes.

I could do it again but I would prefer a less painful way of doing so. If there isn't, I will just do it again the hard way. Or I could take a whole vicadin instead of the half I'm taking now (im actually supposed to be taking 4 a day as needed... but I can't afford to be loopy. I have school deadlines to meet in the next few days and being off my feet is bad enough withough wasting time not able to think straight.)

In total after the surgery, I am (supposed to be) on 4 vicadins (7.5/750) a day and am actually on (taking the way im supposed to) 3 500mg keflex pills a day.

ANYWAY, Any advice would be appreciated. Thanks a bunch.

[billydog]

I'm not a doctor, but maybe you could soak it for a little while in warm water than try to to take it off?

[jh0n]

I Looped a dirt bike when I was a kid, 70 mph on rough pavement, skun my *** really well. The emergency dept. at the hospital put this sticking plaster on the cheeks there, and then next day I rather foolishly went to the city and back on the back of a friends street bike, was sposda get the dressing changed but didnt. So, 2 days later i am **** skeered, its stuck on there like gelcoat. I go to my regular doc and say pleading, can ya get it off man, with out it killing me? SURE!! no problem, sadi he had some stuff that would lift it off like nothing and left the room and me laying face down on a table to get it. Son of a ***** snuck back and SSSCRRREEEEKKKK!!! ripped both plasters off along with about 60 ot 70 thou of *** skin scab. Made my eyes water I can tell you. He put some stuff on that he garanteed wouldnt stick but he lied to me before so I got in the tub with a bottle of tequila and soaked it off. I dunno if soaking is the right thing for you but it works for me, I thought atleast laughing at my misfortune would cheer you up.

[SuperGLS]

Try the Health and Wellness forum on HP. Doc is a dcotor and he helps out people. Pretty interesting forum to find on a Hyundai site.

That is, if you don't get any help here.

[XTRAWLD]

I don't know if getting the scab wet again is good. It's purpose on top of the "injury" is to cover it while it begins to heal underneath the scab.....I've only had a bandage stuck on once really really bad and I just gingerly took my time getting it off. Using careful hands I pulled away the bandage as far as it would go and with pointy scissors or tweezers taking the dressing away from the scab, like peeling it away and using the scissors to help cause my fingers are too big to get in there,...it's very time consuming but it doesn't hurt as much as ripping it off totally, and you are protecting the scab. In addition, you might still see fibers from the bandage sitting there after you get it off.... LEAVE EM...it hurts to take out a small strand of gauze. Hope you find something to help you.

[sed]

well when i had my 7, yes 7, surgeries on my knees, I had time to come up with some ideas of taking bandaging off.

The most effective way I figured out was to take a full vicodin or percocet and let it sit for 20-30 minutes, and then, cut the top layer off with scissors, then slowly peel away the top layer. If all goes well then you will have the next layer with no blood on it, if there is blood, then take some hydrogen peroxide on a cotton ball and dab, just dab away at the blood spots, that will help release the bond that the dried blood hasa on the bandage. When you can move it without pain, have someone or you, cut away the next layer. Just cut a line strait through, and peel. Like porqupines have sex, VERY CAREFULLY!!! lather rinse repeat till all bandages are off. Like XTRAWILD said, if you have small pieces of fabric in the actual wound, don't try to pick them out, it will open it up and will hurt A LOT.

I mean, I have two 10 inch inscisons on both my knees, so if I could do it, you can do it!

good luck man, and don't worry about your school, if you are in pain, take the meds. Don't be a hardass about it. 1 full vicodin when you are in pain will do only what its supposed to do, take away the pain.

offtopic: common misconception of pills is that if you seriously need them, and take the prescribed amount it will make you loopy, that is not true. They will release seratonin and dopamine in your brain, and block the brain from re-absorbing the chemicals for a set amount of time, thats why it sucks coming off them. and you get hot and itchy. Its only when you take more than the prescribed amount or take them recreationally that the dopamine and seratonin has nothing to do and is released into your blood stream and absorbed by your muscles, that you get "loopy". /offtopic

shawn :)

[DocRxGLS]

Just for everyones clarification, I am a doctor of pharmacy (Pharm.D.) not a doctor of medicine (MD) - hence my screen name. Wound care is not exactly my specialty, but proper dressing changes is important. Using non stick gauze, and maybe paper rather than plastic tape might help some. Some tape maybe marked for sensitive skin, and may come off easier than regular tape. Also, you may want to get a little of the "sticky" off the tape by sticking it to your palm and pulling it on and off a few times before it is applied to the dressing, hence it will come off easier. Also, a little water on the tape (not drenching it) to help get it off is probably just fine. Just make sure the wound is as dry as possible afterwards. Blot to dry (i.e. dab dab), do not rub, or you may wipe away the existing clot.

Eventually, when it starts to heal, you are going to want to expose it to the air. The drying of the wound will aid in the healing process, but obviously, cover it up well with your shoes on. A damp sneaker can harbor some really bad bugs including Pseudomonas. DO finish all of those cephalexin (Keflex), and there is nothing wrong with taking narcotics for pain when you really need it. Better to take them on schedule routinely until the pain starts to subside rather than trying to do without and then try and get it back under control later. Taking some naproxen sodium (Aleve) or ibuprofen (Advil, Motrin) just as long as you do not have stomach problems, or an allergy to aspirin or NSAIDS, may give some some additional pain relief so you do not need your hydrocodone as much. Just make sure you have food in your stomach when you take either. Hope that is at least a little help.

Dr. David

And Re: off topic, what Sed said. This is true for SSRI drugs (selective serotonin reuptake inhibitors), which may take 4 to 6 weeks before you get a therapuetic effect, and if coming off of them, they need to be titrated down slowly, not abruptly. This is also true for some other antidepressants and anxiolytics (anti-anxiety) meds.

The side effects for these drugs (SSRI's) - hot flashes, restlessness, itching, and too many more to name are experienced when you first start the meds before you reach the 4 to 6 week target. Usually if you hang in there, these side effects will lessen or go away the further along you go. Taking them recreationally will either do nothing or give you those side effects.

[sed]

also, just to add something. The generic pain relieves, hydrocodone and such are cut with acetomeniphine (sp) which is tylenol. DO NOT TAKE TYLENOL OF ANY KIND when taking these medicines, tylenol is SUPER dangerous in high quanitys, if you are taking a 7.5/750 then that is 7.5mg of narcotic and 750mg of tylenol. If you are supposed to take 4 a day then thats just about the limit a day. Also, if you drink more than 3 alcoholic beverages a day make sure you tell your doctor/pharmasist, as this also can mess up your liver hardcore when mixed with tylenol.

So, long story short take an aspirin or ibprofuen based pain killer in substitue of the narcotic, NOT A TYLENOL OR TYLENOL SUBSTITUE. I wound up in the ER because the doctor told me to take tylenol instead of every 2nd pill and i oded on it. NOT FUN.

shawn :)

[DocRxGLS]

Sorry, but still on Sed's comments, yes, that is very important as well. Going over 4g (4000mg) of acetaminophen (Tylenol) a day can be hepatotoxic (hurt your liver). That equals 8 of the hydrocodone products that contain 500mg of APAP (short abreviation used for acetaminophen) per tablet. So be very careful if taking plain tylenol with these other products.

Oh, and for all you party people that drink heavily and get hangovers, you are pretty much screwed both ways. Alcohol takes precedence in being metabolized in the liver. So, if you are taking tylenol too, if gets put on hold. tylenol is converted to a toxic metabolite that is usually metabolized to a non-toxic compund shortly thereafter if you have a good functioning liver. Since alcohol is taking precedence, then more of that metabolite can build up, and to make a long story short, you could kill your liver, and lose your life. Many children have died whose parents may have just given them a large dose of alcohol based cough syup (hence why very few formulations still include alcohol), and a large dose of tylenol to combat their fever.

If you go the other route (aspirin, naproxen, ibuprofen), alcohol is very irritating to the GI mucosa, and so are the drugs I just mentioned. You may be setting yourself up for a stomach or other GI bleed from mixing these agents.

[mrhoaf]

My grandma skinned up her arm pretty bad a couple months ago, and we used non-stick bandages...they actually had a thin layer of porous plastic on the outside, with traditional gauze-like material in the middle. We also applied a antibiotic cream to the bandage as well. Then I wrapped it to hold it in place. It would stick a little, but nowhere nearly as badly as gauze.

[sed]

hey doc, I'm pretty smart for an end user huh? ;)

just to show experience is sometimes just as good as education!

jfwy

shawn :)

[jh0n]

I had that once for burns Hoaf, can`t recall what it was called. Its the cream that is the big non sticking agent, probably not the best thing for a surgery`d foot. Still all the best to you, dragonfighter! It sucks to be incapacitated.

[DocRxGLS]

hey doc, I'm pretty smart for an end user huh? ;)

just to show experience is sometimes just as good as education!

jfwy

**In a Darth Vader tone** "Impressive" ;)

It may not be as good, but it sure does help. Some of my classmates were several years younger than me, and had never worked in a pharmacy before. All of these drug names and disease states were new to them. I had worked in a pharmacy 6 years before I went to professional (pharmacy) school. After 8 years of undergrad, and 6 years work experience, I did have a leg up on everyone when I got there, and I would not trade it for anything. :thumbsup:

So, when all was said and done, and I was fortunate to get both: 12 years of college, and 10 years work experience before starting my professional career.

[dragonfighter60]

So, yeah I have been walking on them all day today (doctor only told me 24hrs) And thankfully, the bandages didnt stick again. I was so happy. But i just looked into the mirror and my eyes are very, very red. bloodshot. I wonder what that is from? I guess I'll ask the doc tomorrow.

[tricked03gls]

Im a emergency room tech and a nurse tech lol does any of that count

[Jlivan]

hey doc, I'm pretty smart for an end user huh? ;)

just to show experience is sometimes just as good as education!

jfwy

shawn :)

Yeah, maybe too much.....j/k :D

So, chewable morphine would come in handy in this particular situ? Now I know not a lot of people have that readily available, will smoking crack have the same effect? You can also have any good friend hit u over the head and then when you are out have them pull it.

[southpawboston]

i'm not a doctor, but i play one on TV... :D

i have a philoshophy doctorate (Ph.D) in molecular biology. i engineer custom DNA molecules and work in drug development, but i don't know JACK about medicine, haha...

interesting comment on the effects of alcohol and pain relievers, docRX. didn't know that.

[sed]

dayum, i brought it up first, wheres my props?

jeez just cause i take drugs and don't make or prescribe them, I have feelings too!!!!


:D

shawn :)

[oregun]

offtopic: common misconception of pills is that if you seriously need them, and take the prescribed amount it will make you loopy, that is not true. They will release seratonin and dopamine in your brain, and block the brain from re-absorbing the chemicals for a set amount of time, thats why it sucks coming off them. and you get hot and itchy. Its only when you take more than the prescribed amount or take them recreationally that the dopamine and seratonin has nothing to do and is released into your blood stream and absorbed by your muscles, that you get "loopy". /offtopic

shawn :)


I am SOOOOO impressed. Sed gets props for
1) Knowing about two major neurotransmitters
2) Understanding reuptake inhibition
3) Being such a stud, in general, and because you like to pick scabs :)

I know there are a couple people in the medical field on the board so I will pose this question.

Is there a less painful way of removing bandages over surgery wounds other than just taking them off by ripping everything open again? (not stitched just the blod clots and the bandages are stuck to it horribly. Then when i take it off 1) it hurts A LOT and 2) it all starts gushing blood again.) I can't get it wet. Its my 2 big toes.


am actually on (taking the way im supposed to) 3 500mg keflex pills a day.

ANYWAY, Any advice would be appreciated. Thanks a bunch.

Definately use a "non-stick gauze pad" as the first layer on your wound.

Johnson & Johnson and a few other companies make them. Then slap on all the gauze to absorb the draining fluid you need over the top of it.

When you go back to see your doctor, he should also have available to him a nonstick surgical dressing which is basically a sterile, ointment saturated single layer of netting/guaze. You would, again, put that on as the base layer to your dressing. That has the advantage of providing some vitamins/moisture to the scab and keeps that top layer "soft" enough to remove easily.

And please, take all of your anitbioitics. Even if (IMHO) it smells like bad eggs.

[mtlelantra]

Curad "Ouchless" pads. I tore up my legs playing ball and cycling on various occasions and have sworn by them for road rash.
A little off topic but just wanted to tell it cuz it's gross- I got a really bad road rash on the skin over the front muscle to the outside of my shin. After it scabbed over I wanted to stop using the pads. I kept using the polysporin. So the first day I went without the pads I was wearing shorts and talking to my boss when a colleague came over and glanced at my leg and nearly puked... the polysporin had slowly "dissolved" the scab so that this gross platelet goo was running out of the wound and down my leg. Needless to say I kept a pad over it until real skin started forming.

[DocRxGLS]

i have a philoshophy doctorate (Ph.D) in molecular biology. i engineer custom DNA molecules and work in drug development, but i don't know JACK about medicine, haha...

Wow SPB, you have a broad knowledge base. I spent my first two years of undergrad in nuclear engineering before switching back to my first love, pharmacy. All I needed was spanish to get my bachelor's in biology (most of my upper level classes were in micro & biochem). However, after 3 years of trying to get into pharmacy school, when I finally got the letter to go, I was going, B.S. or not. Not going to summer school to finish allowed my wife and I to get married before we moved too.

(off-topic) Computers had become a hobby of mine, and might have well became my career if I did not get in back in 2000. Now, its still my hobby, thank God. I have built 5 new computers in the last 5 years - but Elantra modding is slowly taking over. I got a big laugh on the oil cooler "heatsink" thread and the artic silver reference. I guess you could call me an AMD "fanboy".

So, Oregon, are you planning on private practice, or research? I would almost guess research seeing you are in a dual degree program. Three of my classmates were doing a dual Pharm.D. / Ph.D, but only one left currently who will actually finish.

[oregun]

The crystal ball says that I'll most likely end up in academic medicine/ clinical research.

I've met a few Pharm.D's and I think they are super cool. This one lady was the infectious disease expert at a local hospital and man, she knew the in's and out's of every antibioitic there was.

I have a hard enough time remembering the names of all the cephlosporins.

[DocRxGLS]

This one lady was the infectious disease expert at a local hospital and man, she knew the in's and out's of every antibioitic there was.
Sounds like a member of our faculty who taught us antibiotics. He would keep getting beeped during class by the micro lab at the hospital where he worked. What was freeky, he looked like carrot top and Bill Nye the science guy swapped DNA strands.

I have a hard enough time remembering the names of all the cephlosporins.

Same here along with all of the other classes of every other medication I am supposed to know, lol. The peripheral brain in the pocket (My Palm Zire 72) is my best friend. I try not to rely on in too much, but mainly use it when A) I have a brain fart or B) To double check myself

[dragonfighter60]

Well I saw the doc yesterday, (of course he has nothing non-stick...or just didnt use it) But he put me on another antibiotic as well. so now im taking 3 keflex and 2 cipro a day ugh i hate pills

[DocRxGLS]

...2 cipro a day ugh i hate pills
I hope someone went over the special considerations for Cipro w/ you. If you take a multiple vitamin, or true antacids (tums, maalox, mylanta, or rolaids), or iron, zinc, or calcium supplements, you are either going to have to take them in the middle of your dosing interval (at every 12 hours - 8 & 8 or 9 & 9 would give you some room at about 2 PM to take those other things if needed). Divalent and trivalent cations (calcium, aluminum, magnesium, zinc, copper, etc....) can bind up your cipro, and decrease its absorbancy up to 60-70%. We want you to get the full benefit of your dose, and knock whatever is going on out. The literature will probably say wait 2 hours after the above mentioned things, but I usually recommend closer to 6 hours if possible (easy to do in a once daily regimen, but a little tougher in a twice daily one). This includes dairy - milk, cheese, and yogurt.

As far as side effects, metallic taste has been reported, and it will make you more sensitive to the sun (wear some sunscrean if going outdoors). The oddball one with it (in regards to its other fluroquinolone cousins) is it affects how your body metabolizes caffeine. So, if you drink a pot of coffee a day, or 6 or 8 mountain dews, you may want to cut back some. Normally, you are drinking another soda or cup of coffee after the last has worn off (3-4 hours in adults) but there will still be some residual caffeine left over that your body has not gotten rid of yet if on Cipro, and you would be adding to it.

[oregun]

Hey DragonFighter - you don't have to answer, but I'm curious what happened to your toesies, and when it was done.
Also, your doc is really pouring on the G.positive coverage - do you actually have an infection that was cultured (like staph), or is he trying to prevent an infection due to diabetes or something?

[dragonfighter60]

I had ingrown toenails that I stuipdly waited to take care of. There is an infection deep in the right toe that he is trying to knock out with all of the meds. He also had to cut some skin off and a chunk off of the top of the toe. So that also has something to do with it.

And nobody went over the specials of Cipro with me.. but I always read up about a drug before I take the first dose just to make sure I'm not taking it wrong and to watch for side effects. Sadly I'm an avid milk drinker but I can't for a while i guess :(

All in all though, I'm thankful that the nails are gone. I am in less pain now and its easier to walk onthan before. It was both big toes and that was a bugger and a half to walk on.

[DocRxGLS]

Did they give you Cipro (twice daily) or Cipro XR (2 tablets once daily)? If the latter is what you got, then drinking milk is fine in the afternoon and evening. If the former, you could still have a glass mid day (2 PM ish) if you were taking the doses at 8 & 8 or 9 & 9.

Cipro is mainly used for gram negative infections, and about the only bug in this case that may be beneficial is coag-neg staph. It is the only fluroquinolone that has some Pseudomonal activity (gram -), and its overuse has led to resistance in strep groups, so newer ones are being used (moxifloxacin, gatifloxacin).

[dragonfighter60]

It Cipro twice daily. He said something about cultures not coming back yet. then told me to take the cipro.

[oregun]

I was wondering about the Pseudomonas, in particular. Foot infections are in a class of their own as far as complication.

I hope everything turns out in your favor. I'm sure it will