3:22 PM Today i drove on I5 at a peak traffic hour all the way to Emanuel Legacy close to downtown Portland. Would not have made it so easily without Google Maps.

I have been examined by a wound care doctor and he prescribed a silver based ointment. He confirmed the rims of the wound are made of "healthy newly granulated tissue" which is the beginning of healing. I would say the wound is about 1 mm smaller than it was about a week ago when i stopped using the Xeroform and applied ointment only on the eschar.

So far my main criteria when changing bandage was discomfort after a number of hours, probably due to infection re-starting after the topical triple ointment lost its concentration due to absorption of antibiotics thru skin. I believe the Augmentin that i applied to healthy skin next to wound were being absorbed as well and contributed with keeping the infection away since upon removal they were not having that pungent antibiotics smell anymore.

Silver sulfadiazine does not loose that antibiotic property after a number of hours. Until now which i 6 hours away i did not feel the need to change it.

I remember i asked in the ER a silver based ointment but she said she prefer the bismuth (another metal) based one, the Xeroform which id in the form of pads. Problem with that is it keeps the rims of the wound too moist and they start macerating (getting soaked with moisture, turning white) which prevented healing. The silver sulfa is also being applied only in the center in the wound though she applied a lot and it may had went over the rims.

When Angela asked how much it should be applied the nurse said "like buttering a bread" but to me it looked more like "frosting a cake".

They were no "cognitive barriers" in understanding the procedure except i did not understand why she used such an amount. Maybe i should take the bandages off to look for maceration.

5:28 Ok, i looked, the wound is doing well, the rims look white now and there is some maceration at least in one corner. I applied a smaller amount (barely covering the hole in the skin). Did have some chills and a mild irritation after. Doctor just called and he said i should do an MRI (which i asked for this morning, he initially said only in case of signs of infection but then he asked me if i got the blood drown cause he does not see the results yet).

That and the chills prompted me to take an Augmentin.

A bit earlier some kids knocked at the door.  Angela went after them to see where they were going and it looked like outside the complex, through the new "park". It happened the same two days ago or the day before we had a flat.

8:40 One gram of ointment contains 50 mg of bacitracin (an antibiotic). You can spread it lets say on 2 square inches. For triple antibiotic (brand name Neosporin) one gram contains @100 mg antibiotics so it is not difficult to achieve systemic therapeutic concentration or greater by rubbing 5 grams of ointment on several square inches of skin.

However i use Amoxicillin or Augmentin 500 mg or 1000 mg dissolved in water on two square inches which gives me in a few hours a concentration much greater than if i take them orally because this type of absorption bypasses, like an IV, first pass liver absorption and metabolism which is about 50% so it has much greater bioavailability. 

9:25 They gave me a bottle at doctor's office. But for some reason, after i used it i felt the opposite of what i felt at the office. Chills, burning sensation, pain that was spreading to the bones so i took Augmentin and put a patch with two Amoxicillin.

It is true, in here we have a high level of contamination with all kinda stuff. There was big sack full of old garbage, broken, near the bin. When i got home there was a dog poop near the hydrant near our door. Augmentin got washed out of my system. Silver sulfadiazine goes only in the eschar, but the skin around it is also infected and that area has the poorest circulation in my whole body.

And somehow my phone got out of airplane mode and wi-fi was turned on instead. Now everything hurts also because of that and is hard to tell. 

Then i wanted to go at Walmart to pick the jar they prescribed for me. But at Walmart should better pick whatever you don't need right away cause you never know.

11:48 No luck with test results for A1C either.

11:55 I could not not look at the wound again. Especially since it's been hurting all evening. Wound is doing fine, granulating, skin growing on the right side, but there is an infection on the left, where circulation is poorest. The reason i get chills and pains spreading and i have to take antibiotics, both orally and in patches.

That infection is on and off ever since. Today's doctor said i had triphasic wave at 3 arteries and biphasic (poorer) at the left side of the left foot which is consistent with its color or where skin is not growing. Unlike they found at Meridian Park imaging, that says i have normal (triphasic) on all sides. Just uploaded a pic on New shared but for some reason i cannot understand, they are not in order.