I was referred from Pasir Ris Polyclinic to Singapore General Hospital Clinic J Plastic, Reconstructive & Aesthetic Surgery. My first appointment at Clinic J was 15 May 2019. I was introduced to the recommended dressing for my pressure wound with exudate, which consists of AQUACEL® Ag+ Dressing, Biatain Non-Adhesive, and 3M™ Tegaderm™ Transparent Film Dressing. The total cost of my treatment on that day was a whopping SGD $218.06 after subsidy, which took a large chunk out of my monthly take home salary of about $800. The reason for the large sum was that out of $218.06, $149.40 was paid for consumables, which has no subsidy. Consumables refer to my dressing set, of which Aquacel Ag+ is the most expensive, followed by Biatain, and then Tegaderm. It can be said that I do not have a choice as my infected wound had been growing larger. If this continues, I may get sepsis. As it is, I was already getting inflamed/swollen lymph nodes in my left groin, corresponding to my left ischial ulcer/pressure wound. There is undermining of the wound, insufficient inflammation, and a failure to induce proliferation of skin tissues.
Evidently, I can't apply the dressing by myself because I can't even see the wound, so I need help from my mother, who graciously agreed to be my nurse in the application of the dressing. I understand that it is not easy for someone older than 70 to learn new things, especially something as gross and dirty as wound cleaning, and I'm thankful for her courage. However, age brings with it medical problems, and my mother is not free from them. If she has to stay in hospitals in future for surgeries, I won't have any dressings done. We went back to SGH on 17 May 2019 where a nurse taught her the ways to apply the dressing by applying the dressing on me. In addition to the dressing consumables bought from SGH, we also had to buy some dressing consumables from CGH for all the sterilised tools needed for dressing. In total, the additional consumables comprise of a basic dressing set, a tube of saline solution and 1 or 2 swab sticks, which are thrown away after each use per day. Each cost about $2 per use per day. Although this adds to the total cost, it is still cheaper than having to go to the hospital or polyclinic daily for dressing application, which will cost about $12 each time/day. This is not even considering the numerous number of no pay leaves I'll have to take when I run out of sick leave and annual leave.
As it turns out, my mother and I had no knowledge whatsoever about the quantity of dressing consumables required for each day at the beginning, nor the standard sizes of consumables which are to be bought at SGH. The dressings has to be changed each day when I come home after work and bath, because the dressings usually do not last a bath, and sometimes, they break while I was using the toilet at work due to my sitting on the toilet bowl for both urinating and moving of bowels. Hence, I've learned to stand up to urine into the toilet bowls 5 days a week, but as for my movement of bowels 2 days a week (several times on each day inclusive of urinating), there is no avoiding tearing the dressings.
I next saw another doctor on 28 May 2019. It was then that the doctor recommended suturing/stitching the wound. However, due to the large quantity of unused dressing consumables (I bought too many on my first appointment, courtesy of my first doctor who did not advise on consumables, but simply quoted regular numbers), I decided against it. On that appointment, I spent $64.16, of which $41.16 was for the doctor's debridement of my wound and the nurse's application of the dressings.
I next saw another doctor on 13 June 2019. However, this doctor did not recommend suturing. Instead, he suggested that my wound may heal in 2 months time, so he gave me another appointment on 11 July 2019. As for the dressing consumables, due to a misunderstanding of the standard size for biatain, I was given sizes too large, which take a longer time to cut up and use, and cost more. Hence, my medical bill shot up to $183.06, of which $141.90 was for dressing consumables.
On 11 July 2019, another doctor saw my wound and again recommended suturing, but he suggested a few do's and don't's which caused me to think twice about it. After the suturing, I had to take at least 10 days of rest from work and when I sit, I must refrain from sitting on the sutured wound as this may break the sutures/stitches. This means that I may not be able to sit at all because an improper way of sitting can put strain on my injured back. The doctor even suggested changing my way of lying in bed. My next appointment is on 1 Aug 2019, where I won't have other medical appointments until 23 Aug 2019 in IMH for my regular psychiatric appointments. This means that I'll be able to take 5.5 days of consecutive medical leave from work. This is in addition to the weekends and national day holiday on 9 Aug 2019, which adds up to about 10 days of rest. I'm praying that my wound will have healed sufficiently by that time.
09 Aug 2019 Update
On 1 Aug 2019, the doctor who saw me did not recommend stitching. She gave the reason that there is not enough equipment to do stitching, and that if stitching is to be done, a separate appointment for a different surgery room has to be made. In addition, she stressed that surgery will require at least 2 weeks MC. Instead, she prescribed a new type of dressing in addition to the ones I have, the Steri Strip, which acts like a sticky tape to hold the edges of my wound together. So far, it has made my wound smaller, but the hole is still there and there is still exudate emission. Each packet of Steri Strip cost $5.61 and can be cut up and used 4 times, once for each day of dressing change, so this adds about $1.40 to my daily dressing costs for consumables. On 1 Aug 2019, I spent a total of $97.23 for my medical bill, including the buying of consumables. On 2 Aug 2019, my mother went to CGH to buy other consumables, some at a cheaper price, costing a total of $40.30.
Evidently, I can't apply the dressing by myself because I can't even see the wound, so I need help from my mother, who graciously agreed to be my nurse in the application of the dressing. I understand that it is not easy for someone older than 70 to learn new things, especially something as gross and dirty as wound cleaning, and I'm thankful for her courage. However, age brings with it medical problems, and my mother is not free from them. If she has to stay in hospitals in future for surgeries, I won't have any dressings done. We went back to SGH on 17 May 2019 where a nurse taught her the ways to apply the dressing by applying the dressing on me. In addition to the dressing consumables bought from SGH, we also had to buy some dressing consumables from CGH for all the sterilised tools needed for dressing. In total, the additional consumables comprise of a basic dressing set, a tube of saline solution and 1 or 2 swab sticks, which are thrown away after each use per day. Each cost about $2 per use per day. Although this adds to the total cost, it is still cheaper than having to go to the hospital or polyclinic daily for dressing application, which will cost about $12 each time/day. This is not even considering the numerous number of no pay leaves I'll have to take when I run out of sick leave and annual leave.
As it turns out, my mother and I had no knowledge whatsoever about the quantity of dressing consumables required for each day at the beginning, nor the standard sizes of consumables which are to be bought at SGH. The dressings has to be changed each day when I come home after work and bath, because the dressings usually do not last a bath, and sometimes, they break while I was using the toilet at work due to my sitting on the toilet bowl for both urinating and moving of bowels. Hence, I've learned to stand up to urine into the toilet bowls 5 days a week, but as for my movement of bowels 2 days a week (several times on each day inclusive of urinating), there is no avoiding tearing the dressings.
I next saw another doctor on 28 May 2019. It was then that the doctor recommended suturing/stitching the wound. However, due to the large quantity of unused dressing consumables (I bought too many on my first appointment, courtesy of my first doctor who did not advise on consumables, but simply quoted regular numbers), I decided against it. On that appointment, I spent $64.16, of which $41.16 was for the doctor's debridement of my wound and the nurse's application of the dressings.
I next saw another doctor on 13 June 2019. However, this doctor did not recommend suturing. Instead, he suggested that my wound may heal in 2 months time, so he gave me another appointment on 11 July 2019. As for the dressing consumables, due to a misunderstanding of the standard size for biatain, I was given sizes too large, which take a longer time to cut up and use, and cost more. Hence, my medical bill shot up to $183.06, of which $141.90 was for dressing consumables.
On 11 July 2019, another doctor saw my wound and again recommended suturing, but he suggested a few do's and don't's which caused me to think twice about it. After the suturing, I had to take at least 10 days of rest from work and when I sit, I must refrain from sitting on the sutured wound as this may break the sutures/stitches. This means that I may not be able to sit at all because an improper way of sitting can put strain on my injured back. The doctor even suggested changing my way of lying in bed. My next appointment is on 1 Aug 2019, where I won't have other medical appointments until 23 Aug 2019 in IMH for my regular psychiatric appointments. This means that I'll be able to take 5.5 days of consecutive medical leave from work. This is in addition to the weekends and national day holiday on 9 Aug 2019, which adds up to about 10 days of rest. I'm praying that my wound will have healed sufficiently by that time.
09 Aug 2019 Update
On 1 Aug 2019, the doctor who saw me did not recommend stitching. She gave the reason that there is not enough equipment to do stitching, and that if stitching is to be done, a separate appointment for a different surgery room has to be made. In addition, she stressed that surgery will require at least 2 weeks MC. Instead, she prescribed a new type of dressing in addition to the ones I have, the Steri Strip, which acts like a sticky tape to hold the edges of my wound together. So far, it has made my wound smaller, but the hole is still there and there is still exudate emission. Each packet of Steri Strip cost $5.61 and can be cut up and used 4 times, once for each day of dressing change, so this adds about $1.40 to my daily dressing costs for consumables. On 1 Aug 2019, I spent a total of $97.23 for my medical bill, including the buying of consumables. On 2 Aug 2019, my mother went to CGH to buy other consumables, some at a cheaper price, costing a total of $40.30.