A Silver Bullet for Bumblefoot's "bed sore."

The time has passed for Bumblefoot to avoid his bed-sore-like case of bumblefoot - by having instituted a regular regimen of swimming, and catching and eating his own food.  Like humans with bed sores, it may simply be too late to get regular exercise and eat right.  His foot hurts, and to make matters worse, Bumblefoot, like many bed and wheel chair bound human sufferers, is depressed.

The "normal" bacteria living on his skin have discovered in his open wound a rich feeding ground and are voraciously feeding and lustily breeding.  As in humans, open sores universally and unavoidably become contaminated - every one of them, in everyone eventually, and in Bumblefoot in particular.  There is just no avoiding contamination by the opportunistic bacteria that live on his and our skin when given access to a succulent feast.  Left unchecked in bed sores and in penguin pododermatitis, bacteria can be expected to be so successful as to interfere with a body's natural healing mechanisms.  Left untreated or unresponsive to treatment, pressure ulcers kill - and badly.  Most know that Christopher Reeve fell off his horse, paralyzing him .  Few know however, that the coma from which he never awakened was caused either directly by the systemic sepsis that began in his infected decubitus ulcer or by the medicine administered to treat it.   

Unlike other "Never Events,"  like removing the wrong limb, or discharging a newborn to the wrong mother, or transfusing the wrong blood type, or losing a demented patient, pressure ulcers are not always cases of neglect or heinous error by care givers.   Sometimes, no matter what protocols are employed, bad things happen.  Bumblefoot will be treated with wide spectrum range antibiotics.  Those medicines may be expensive or worse.  They could prove toxic to him.  To Granny too.

The care-giver's infection control strategies will include prioritized cleaning routines and diverse debridement methods - all designed to keep the bacteria count down.  No one method will guarantee a successful outcome.  But the closer the antibiotic is to a precise indication for the offending bacteria, the more likely it is that Bumblefoot will survive his never event.

Bacteria deposited on brass doorknobs are all likely killed in less than eight hours, a nifty by-product for the occupants of old Victorian homes.  Microscopic bugs just do not like heavy metals.  The good news for Bumblefoot and for humans with bed sores is that bacteria, most anyhow, like silver even less.  For Bumblefoot, the next step is an hydropolymer dressing  with ionic silver - all neatly encapsulated in a cute neoprene bootie.  Expect a similar plan if Granny has an open bed sore.

Bumblefoot has a "ZAC." Humans can get "HACs."

A "Zoo Acquired Condition" is the Palliative Penguin's definition of a ZAC.  Bumblefoot got his ZAC at the zoo.  Bumblefoot did not arrive at the zoo with bumblefoot.  He got his pododermititis there.  No one who is responsible for animals at a zoo is happy about ZACs.

Humans can get "Hospital Acquired Conditions."  The folks at Medicare and Medicaid who control the money label an HAC as the near unforgivable, and certainly not fund-able, "Never Event."  A bed sore is only one of the Never Events.  There are lots of HACs.  No one likes them.  HACs cost hospitals money, probably righteously, and hurt patients, worsen their conditions or kill them.  Nothing good ever comes of a Never Event.

The concept can be extended to all caregivers, whatever the context.  A HAC can be thought of as well, as a "hospice" acquired condition or it could come to mean a "home" acquired condition.  Whatever the care-giving context, a Never Event is not the event, condition or thing that any responsible person would want to have killed Granny or hastened her death.  The zookeepers  have the same expectations for Bumblefoot.

Bumblefoot's avian vets are planning a medical intervention.

Bumblefoot has a nasty case of bumblefoot, a "pressure ulcer" to you humans.

Bumblefoot, an Antarctic Emperor penguin, has a nasty case of bumblefoot (pododermatitis), which is common in raptors because they stand around on one foot a lot, and in sedentary penguins who also stand around on one foot a lot.  Bumblefoot is a serious disease, which if left untreated can lead to the death of my penguin buddy of the same name.  Pressure ulcers are no less serious in humans.  A bed sore can kill you.

Bumblefoot's day to day behavior can be compared to that of a human couch potato.  He has deficient nutrition, rarely exercises, is not big on personal hygiene, and rarely takes the advice of his doctor or, in the case of Bumblefoot, his avian vet.  Fortunately for couch potatoes, most do not develop bed sores.  Every now and then, they do get up to visit the frig, the packy and their beds.  Bed bound humans are not so lucky.  They share most, if not all of the contributing factors to Bumblefoot's complaint and they do get pressure ulcers.  Bumblefoot is a huge problem in zoos.  Bed sores are a huge problem in hospitals, nursing homes and for any human who sits immobile in a wheelchair or who cannot, or does not, move around much in bed.

The Association of Avian Veterinarians have more to say about bumblefoot.  The European Pressure Ulcer Advisory Panel (EPUAP) and American National Pressure Ulcer Advisory Panel (NPUAP) have a lot of helpful things to say about bed sores.

More on each later: