Ischemic Foot in Progress

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This was the first time i saw this patient.  He had a Left BKA already, presents with a cold foot.  Ultimately gets vascular studies and no treatment.  Plan was to await full extent of ischemia to become apparent. Patient presents a few months later with the findings in the image below.

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In an effort to preserve his ability to ambulate, a forefoot amputation was undertaken. Images below were form a follow up several weeks later.  It was certainly a rare opportunity to wee this each time in the ER and to participate in the excellent care of this very nice gentleman.

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Large Hiatal Hernia

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This Chest XRAY depicts a large hiatal hernia.  on the AP, it looks almost as if the heart is a water bottle half full (or half empty for you Debbie Downer’s out there). Also COPD id demonstrated with the hyper-inflated lungs and paucity of soft tissues, and a right sided pacemaker. Notice on the lateral how his calcified aorta has to circumnavigate the hernia.
Photos Copyright 2015 William E. Franklin, DO