(From Electronic Medical Record)
Episode of Care:
Diagnoses: Arterial insufficiency; Gangrene right foot; Dementia
Medical History: Left below the knee amputation
PT Start Date: 8/31/2016
PT End Date: 10/28/2016
Number of PT Visits: 24
family had opted not to follow the advice of his vascular surgeon, who recommended a below knee amputation of his right leg to stop the progression of gangrene.
the patient had previously had a below the knee amputation of his left leg due to circulatory insufficiency
extremely poor based upon his history and present status
best practices wound care would not stop the gangrenous progression
septicemia and death
his primary care nurse practitioner opted to try a physical therapy intervention which incorporated the Treadwell™ System
signs of progress within the second week
improved range of motion of right ankle and toes
observable healing at the gangrenous site
healing was continuous and progressive
odor from the patient’s distal 3rd toe (gangrenous segment) prompted another referral to the vascular surgeon, who no longer recommended surgery
spontaneous amputation of the distal two phalanges of the right 3rd toe occurred
circulation in his right lower leg and foot had returned to normal including healing of his right 3rd toe
I have seen this patient in the facility recently, which is 9 months after this episode of care, and his right lower leg and foot still appear normal with respect to swelling, coloration and induration.
In my professional opinion, had the episode of care utilizing the Treadwell System not been engaged, progression of the gangrenous infection would likely have led to sepsis and death.
Estimates of the cost of a below the knee amputation surgery and subsequent medical interventions begin at $100,000. Had this occurred and the patient survived, he would have had to go to a (more expensive) skilled facility to receive the level of care required for a bilateral amputee.
The total cost of the episode of care delivered utilizing Treadwell™ technology, which was delivered at the facility (no transportation required for the patient to go to an outside facility for treatments) was approximately $3,000, 3% or less of what the surgical alternative would have cost the healthcare system.
Richard Hand, PT
An 83 year old female who resides in a memory care facility diagnosed as having dementia. Prior to beginning her therapeutic intervention using the Treadwell™ System, an evaluation provided the following data:
1. Very limited response to questions; no initiation of conversation or questions
2. Edematous lower extremities (+2 right lower leg and +3 left lower leg).
3. A 1 x 0.35 cm ulceration on the lower/lateral third of her left leg
4. Random blistering of both lower legs
5. A venous clinical severity score of 17
6. The 6 min walk test = distance of 100 feet, with rests intervals every 20 feet
Her one month re-evaluation (31 days) provided the following data:
1. Patient initiated conversation 2 times during session; responded to questions appropriatedly
2. Lower extremity edema decreased by one grade on the right, and two grades on the left
3. Her ulceration was healed
4. Blistering of her legs no longer present
5. A venous Clinical Severity Score decreased to 4
6. The 6 minute walk test = 600 feet without interval rests
Conclusion: Therapy with the Treadwell™ System provided better than expected outcomes in cognitive conversational quality, ulceration healing, lower extremity skin condition, improvement in Clinical Severity Score and 6 minute walk test in the opinion of the writer.
Richard Hand, PT