1. T. was first seen by Dr. Smith, 11-12-02, he had a blister on the bottom of his great toe, left foot. Patient has been debriding and applying Bactroban on his own. Area covers entire bottom of toe. BS has been running very high or low. Patient is a brittle diabetic.

Plan 1: Betadyne soak left toe followed by oxymist spray treatment, recovery balm and Telfa dressing.
Plan 2: Check LIPID panel, HbA, C component panel and CBC & ESR.
Plan 3: Follow-up with pt tomorrow, 11-13-02.

NOTE: All photos between 11-13-02 and 11-20-02 are follow-up visits, further debridement with Oxy-Mist spray treatment, recovery balm and Telfa dressing.

2. On 11-20-02, T. was seen by Sharon Saim, ARNP-C, Wound Care Specialist with more than 20 years experience with this specific specialty.
Plan 1: Wound redressed with 4X4 and kling, pt will do oxymist treatment at home.
Plan 2: May call clinic PRN.
Plan 3. RTC in 1 week for follow up wound care and healing progress.
Plan 4. D/C Keflex, Cipro 500 mgs BID x6 weeks given, script written by Steve Miller, ARNP-C.
Plan 5. Discussed diagnosis of osteomyletis with pt and the proposed treatment with oral antibiotics.

3. On 11-27-02, T. was seen by Sharon Saim, ARNP-C.

Plan 1: Wound redressed with 4X4 and kling with recovery balm. Patient had Oxy-Mist treatment already.
Plan 2: May call clinic PRN.
Plan 3: RTC in 1 week for follow up wound care and wound healing progress.

Will discuss with Dr. Smith the need for conservative debridement of macerated tissue.

4. On 12-11-02, T. once again saw Sharon Saim.

Plan 1: Wound surgically debrided by Dr. Smith.
Plan 2: Oxy-Mist treatment was done. Patient will continue using Oxy-Mist at home. New spray bottle given to patient for treatments. D/C recovery balm at this time.
Plan 3: Pressure dressing applied with 4x4 and kling.
Plan 4: May call clinic PRN.
Plan 5: RTC in 1 week for followup wound care and wound healing progress.

5. T. was treated by Sharon Saim, 12-18-02.

Plan 1: Wounds surgically debrided by Dr. Smith.
Plan 2: Wound redressed with dry 4x4 and tube dressing.
Plan 3: May call clinic PRN.
Plan 4: RTC in 2 weeks for follow up wound care.

6. January 8, 2003, T. was once again treated by Sharon Saim (no photos available).

Plan 1: Wounds surgically debrided by Dr. Smith.
Plan 2: Wound redressed with dry 2x2 and 2" kling.
Plan 3: May call clinic PRN.
Plan 4: RTC in 2 weeks for follow up wound care.

7. January 29, 2003 was T.'s last visit for two weeks, he's on vacation (no photos available).

Plan 1: Peri wound surgically debrided of callous ring.
Plan 2: Wound redressed with dry 4x4 and tube dressing.
Plan 3: May call clinic PRN.
Plan 4: RTC in 3 weeks for follow up wound care.