Need Advice On Decubitus Pressure Sore
#1
Posted 22 February 2007 - 04:37 PM
Last year he lost 60 pounds (to control his diabetes) which is now diet controlled. He developed decubs on each ischium on his bottom and so far we have had no luck in getting them healed.
We have changed everything equipment-wise; bed, chair, cushion, slings. They are healing on the outside, but not the tunneling inside.
Anyone got any advice that worked for them?
Any help would be appreciated.
#2
Posted 22 February 2007 - 07:12 PM
An air mattress bed helped me after a lot of treatment but i guess it didn't for you.For a year
and a half i've dealt with the issue you're bringing up so personal experience counts for something.
Go see a doctor immediately. I did when i noticed a lot of bleeding from my midesection so i went to my gpc and they diagnosed me with a Decubitus ulcer on one of my buttcheeks. I had a breakdown but never had one before,so i didn't recognize it. I had a stage 4 decuitus which was
seriousbecause of the bone infection in my pelvic area(Osteomyelitis). The problem you have and probally don't know it,istheinside has to heal along with the outside,thus many things have to take place.
1. Surgery to allow drainage
2. Antibiotics
3. Wound Vac
Thats the route that started my healing.
A quick timeline for me so you can see what you might be in for.
1. Two week hospital stay with surgery.
2. Weekend at home for home health care.
3. Another 2 week stay in hospital with surgery.
4.Three month nursing home stint.
5. Home health care from March 2006 til August 2006
6. Having someone change my bandage daily since August til now.
It went from over 5 CM depth wise to .1 CM now. I've been seeing a wound doctor every week to every two weeks since last summer.
Listen,healing on the outside doesn't do any good unless the inside is as well. I hope you don't have to go through what i did but if you do,its going to mean a lot of patience,which i'm sure you have,yet wounds take a long time to heal when on your bottom.
Hope that helps.
#3
Posted 22 February 2007 - 07:23 PM
mulepower, on Feb 22 2007, 12:12 PM, said:
An air mattress bed helped me after a lot of treatment but i guess it didn't for you.For a year
and a half i've dealt with the issue you're bringing up so personal experience counts for something.
Go see a doctor immediately. I did when i noticed a lot of bleeding from my midesection so i went to my gpc and they diagnosed me with a Decubitus ulcer on one of my buttcheeks. I had a breakdown but never had one before,so i didn't recognize it. I had a stage 4 decuitus which was
seriousbecause of the bone infection in my pelvic area(Osteomyelitis). The problem you have and probally don't know it,istheinside has to heal along with the outside,thus many things have to take place.
1. Surgery to allow drainage
2. Antibiotics
3. Wound Vac
Thats the route that started my healing.
A quick timeline for me so you can see what you might be in for.
1. Two week hospital stay with surgery.
2. Weekend at home for home health care.
3. Another 2 week stay in hospital with surgery.
4.Three month nursing home stint.
5. Home health care from March 2006 til August 2006
6. Having someone change my bandage daily since August til now.
It went from over 5 CM depth wise to .1 CM now. I've been seeing a wound doctor every week to every two weeks since last summer.
Listen,healing on the outside doesn't do any good unless the inside is as well. I hope you don't have to go through what i did but if you do,its going to mean a lot of patience,which i'm sure you have,yet wounds take a long time to heal when on your bottom.
Hope that helps.
Thanks for the reply, but he has been to a wound clinic for almost 8 months now; going every 1-2 weeks. Even the Doctor is baffled. Wound vac will not work as they cannot get a good seal because of the location. Looking to see if anyone has any suggestions or if something they did worked for them.
#4
Posted 22 February 2007 - 11:15 PM
The timeline for mulepower seems a bit long to me. The way it is written it seems as though he has been fighting his sore for a year and a half or more. And still dealing with it. It just doesn't sound right. It has never taken longer than 5 months for a wound on my rear to heal with surgery or not. You have to add recovery time to that. My wounds were so deep it started into the bone.
I had two sores (one on each ischeum or however you spell it). I was like your husband; no pressure sores for about 12 years. I had been using a jay cusjion since my injury. Back in 2000 or so, jay reconfigured the gel pockets without any notification. The name of the cushion stayed the same but it was a totally different cushion. I use ROHO now.
Anyway, debreedment and muscle flaps did the trick. With the flap, the doctor pretty much goes in and cuts the sore so it is very open. Any dead tissue AND BONE is removed. Wait about two weeks to be sure there is no infection and then the muscle flap. The muscle is usually taken from the back of the hamstring. More bed rest for at least a month. STAY OFF YOUR ASS!
If your doc is baffled get a new doc. It sounds like your husband is a perfect candidate for a couple flaps. It will be probably 8-9 months from start to finish before he can resume a normal routine. For now, he cannot get out of bed. He'll have to turn and stuff but absolutely no time in his chair.
BRETT
Morality, like art, means drawing a line someplace. --Oscar Wilde
#5
Posted 23 February 2007 - 12:28 AM
Hope all goes well!
Amanda
"I wish they would only take me as I am."
- Vincent Van Gogh,
"Dear Theo: Autobiography of Vincent Van Gogh"
#6
Posted 23 February 2007 - 02:01 AM
Quote
My decubitus was a stage four that had a serious bone infection(Osteomyelitis) that took a while to heal. I had some surgery and some of that included opening the wound so it would drain better. They even had to put a hickman catheter in for the specific type of antibiotics. The care at the nursing home wasn't great because only a few of the medical staff knew how to reseal my wound when i was on my wound Vac since it was near my rectum. I had to wait for them to reseal it,which sometimes took way to long.
The bottom wound is just about healed and its really tiny(.1 CM).Silvadene helped a lot for my bottom once it got below 2 CM. The wound doctor is seeing me for a small wound on my foot now and the bottom wound is pretty much healed and thats why only a 2x2 is being inserted so the flaps done't meet.
I think its great your ulcer healed so quickly. One quad i'm a friend with had one that took about a year to heal.The Osteopathic doctors i've spoken to about this said wounds vary on how quickly they heal and many times its how the patient takes care of it.I guess everyone's wound is different. Dr. Foster here at Carillion Community hospital has helped my wound a lot after Dr Long wasn't getting anywhere with it. He and Dr.Hagan were good at surgical procedures but weren't much for outpatient care lol.
The concensus about her husband seems to be get a new doc. Along the nutrient end,my docs,the hospital's nutrionist, wound teacher and home health care nurses stated a high protein diet helps heal the wound quicker. Boost,Ensure and anything with loads of protein will do the trick.
#7
Posted 23 February 2007 - 01:39 PM
mulepower, on Feb 22 2007, 07:01 PM, said:
Quote
My decubitus was a stage four that had a serious bone infection(Osteomyelitis) that took a while to heal. I had some surgery and some of that included opening the wound so it would drain better. They even had to put a hickman catheter in for the specific type of antibiotics. The care at the nursing home wasn't great because only a few of the medical staff knew how to reseal my wound when i was on my wound Vac since it was near my rectum. I had to wait for them to reseal it,which sometimes took way to long.
The bottom wound is just about healed and its really tiny(.1 CM).Silvadene helped a lot for my bottom once it got below 2 CM. The wound doctor is seeing me for a small wound on my foot now and the bottom wound is pretty much healed and thats why only a 2x2 is being inserted so the flaps done't meet.
I think its great your ulcer healed so quickly. One quad i'm a friend with had one that took about a year to heal.The Osteopathic doctors i've spoken to about this said wounds vary on how quickly they heal and many times its how the patient takes care of it.I guess everyone's wound is different. Dr. Foster here at Carillion Community hospital has helped my wound a lot after Dr Long wasn't getting anywhere with it. He and Dr.Hagan were good at surgical procedures but weren't much for outpatient care lol.
The concensus about her husband seems to be get a new doc. Along the nutrient end,my docs,the hospital's nutrionist, wound teacher and home health care nurses stated a high protein diet helps heal the wound quicker. Boost,Ensure and anything with loads of protein will do the trick.
Thank-you all for all your suggestions! We are seeing a new Doc on Tuesday. He already is on a high proein diet along with Glucerna(just like Ensure, but for Diabetics). Current Doc did open one wound up more as it was .5x.3 cm with 5cm tunneling. That now is again closing up outside, but tunneling remains. He also was on a Jay cushion, but now on a roho. Air mattress made things worse. Present mattress has been pressure mapped, so we know that is not the problem. Will see what happens on Tuesday. Thanks again!!
#8
Posted 23 February 2007 - 09:10 PM
And margaret: DON'T LET THAT WOUND CLOSE OVER IF IT IS STILL TUNNELING!! It shouldn't be doing that if you are packing it. What is the current treatmentyou're using?
BRETT
Morality, like art, means drawing a line someplace. --Oscar Wilde
#9
Posted 23 February 2007 - 10:23 PM
I'll tell you what,if you wanna lose weight go to a nursing home and eat their food,you''ll lose weight. I lost close to fifty pounds which i needed too lol.Only the breakfast was good,the rest you had to sort through. Silvadene is awesome and i never heard of it before until i had to be on it. It does work wonders.Where my infection was had to do with being colon related which i don't think were that serious but many of the other ones i had were. Thats one time i'm glad i couldn't feel because the pain for an AB person must be almost unbearable with infections in that area.
Is it MRSA,i looked it up and it sounds really scary if its the same thing.
http://www.associatedcontent.com/article/1...d_superbug.html
I think i had some of my pelvic bone removed.
Margaret,Brackman is so right. Tunneling has to be stopped and the outside is easy to heal in comparision,iiuc. Its great that you seek out help about your husband's situation.You're doing everything you can. It sounds like only a good doc is in order for things to turn around. Going to different docs til one knows what he's doing sometimes takes some time. I don't know why some docs can't just say i don't know and refer to a collegue.
This post has been edited by mulepower: 23 February 2007 - 10:24 PM
#10
Posted 23 February 2007 - 11:41 PM
Almost the same prob with veins. Mine are just so abused the're about gone. Whenever I had an iv clog up I knew I was in store for some pain. Sometimes it took six sticks in varios places. I always beg for a picc line whenever I know I'm going to be staying a while. That was 17 years ago. Where do the years go?!
margaret, good luck at the doc on tuesday. Be aggresive if you need to. Stage 4 ulcers are nothing to laugh at. At the very least, I would ask the doc to have your husband have a bone scan to check for dead/infected bone. Let us know how things go, if you would.
BRETT
Morality, like art, means drawing a line someplace. --Oscar Wilde
#11
Posted 25 February 2007 - 01:32 AM
#12
Posted 25 February 2007 - 05:00 AM
margaret, on Feb 22 2007, 03:37 PM, said:
Hi,
I can well empathize with you. Though I'm just a T4 para, I've suffered decubs, an ulcer on my coxxixfor 7 years and it one point it was so bad you could put a fist in it down to the bone.
I've had several operations from initial grafts, to flaps and none took. At one point they wanted to amputate my leg as that was the only placeleft to get enough muscle to fill the gaping wound.
Bottom line is nothing worked. Finally a friend in Texas called a friend of hers in the Mayo Clinic. They were using a special gel which she sent me.
I still call it my miracle drug. Ithealed me in 9 months. Improvement was slow but steady. Today there's still a slight indentation, but it's closed, I'm healed, and still have my leg.
Call the Mayo Clinic. They WILL help.
Ed
#13
Posted 25 February 2007 - 12:40 PM
As others said... in no way should he get out of bed!

The greatest victory is that which I have yet to achieve! - Enzo Ferrari
#14
Posted 26 February 2007 - 01:14 AM
#15
Posted 26 February 2007 - 04:11 PM
BRETT
Morality, like art, means drawing a line someplace. --Oscar Wilde
#16
Posted 26 February 2007 - 09:45 PM
#17
Posted 27 February 2007 - 06:27 AM
#18
Posted 27 February 2007 - 07:57 AM
I get home and bam,i have three bed sores on my ass and two almost sores on my heels.They are finally gone,but i never knew those air mattress things are so worthless,unless it was just the one they used.
#19
Posted 28 February 2007 - 03:45 PM
ziggy, on Feb 27 2007, 12:57 AM, said:
I get home and bam,i have three bed sores on my ass and two almost sores on my heels.They are finally gone,but i never knew those air mattress things are so worthless,unless it was just the one they used.
Well, we had the appt with the new Doc (a plastic surgeon) who was really called in as a consult and for a second opinion. Did say he was not a candidate at this time for a flap (which my husband doesn't want anyway). Put him on Dakin solution for his wounds. Anybody ever try this? Basically told us what we already knew and what so many of you guys have graciously said here and that is to stay off his bottom. Unfortunately he is not one to stay in bed. Before this happened, it was not unusual for him to be up in his chair for 10-14 hours a day. He has cut that down to 6 hours, but knows that he needs to cut it down to next to nothing. He does have a tilt wheelchair that we thought would be a big help, but found out that after pressure mapping that the tilt function actually relieves very little pressure. We also pressure mapped an air mattress and found the exact same thing which really surprised us, since the Doctor had said he needs this. So, we got rid of that and our present mattress is not only is comfortable for him, but when we pressure mapped that, it showed zero pressure when he lays on his back. Our biggest problem at this point is that the wound care clinic that we go to seems to be giving us what I think is a "power stuggle" problem. We pride ourselves on researching and asking detailed questions all the time. It seems the minute we ask something or bring a concern up, the hackles go up, they get defensive and by the end of the appointment, everyone is upset and I can't understand what the problem is. I don't think they see many people with SCI because for example they refuse to take into account my husband's SCI when they do the dressings. They literally ball 4x4's up so that is what he is sitting on and I'm sorry, but I cannot stand by and risk another decub when I know it takes only minutes for them to develop. So, they get upset when I say, "This may work for ambulatory people, but not for him." So anyways, after we left that appt, had an appt with his primary care Doc who is just wonderful and had more questions answered there than at the wound clinic; go figure. Sorry this went on and on, thanks for letting me vent. My husband knows what he has to do and it is basically up to him to make that compromise to get these healed. So we will see what happens.
#20
Posted 28 February 2007 - 05:41 PM
Your husband has GOT TO respect the seriousness of this issue. As for the dressing: You still have not told us exactly what is being done. We need to know the procedure from start to finish. What is used and how.
We really want to help as much as possible. But, we need ALL the information we ask for. How a wound is dressed is very important. I've asked you at least twice and all you tell me is what you are using. Remember, how the wound is dressed from start to finish. Even the minutest details.
Now, get your husband of his ass and let us help him if we can!
Sorry about "yelling" but this is a serious issue.
Brett
Morality, like art, means drawing a line someplace. --Oscar Wilde
#21
Posted 28 February 2007 - 06:14 PM
brackman22, on Feb 28 2007, 10:41 AM, said:
Your husband has GOT TO respect the seriousness of this issue. As for the dressing: You still have not told us exactly what is being done. We need to know the procedure from start to finish. What is used and how.
We really want to help as much as possible. But, we need ALL the information we ask for. How a wound is dressed is very important. I've asked you at least twice and all you tell me is what you are using. Remember, how the wound is dressed from start to finish. Even the minutest details.
Now, get your husband of his ass and let us help him if we can!
Sorry about "yelling" but this is a serious issue.
I and my husband do realize the seriousness of this issue; we would not be working as hard as we can if we did not think so. You have no idea the hoops we have had to jump through during this ordeal. Anyways, all wounds are flushed with normal saline; then 1/4 inch packing strips are soaked in Dakin solution and packed in wound; then a 4x4 is placed over the wound and taped; then an ABd placed over the 4x4 and taped to secure. That is it, it is done twice a day. Any suggestions are welcome; even "yelling"!! I can only "nag " so much. I have gently told my husband, even before yesterday's appt that we have addressed every issue that we can; the only place that needs improvement is the amount of time he is on his butt and he is, I think finally accepting the reality and as of this morning told me to get some movies and word search books to keep him occupied while in bed. It's a start.
Brett
#22
Posted 28 February 2007 - 06:24 PM
I'm not sure what hemisphere you are in... but if you have access to sunshine, some rays on his bottom everyday will do him good!

The greatest victory is that which I have yet to achieve! - Enzo Ferrari
#23
Posted 28 February 2007 - 06:52 PM
The best I can tell you from my point of view is, you have to have a doctor that knows what he/she is doing. And a team of doctors working together for the same goal is better. We have been very fortunate to find what I think is the BEST doctors in the business.
The clinitron is the best bed to be on. We request them in hospitals, and we have been fortunate enough to have a doctor with enough pull to get us one at home.
He's on a wound vac, but those don't really have me sold. Been off and on one for all these years.
Bed rest is a MUST!! My husband stays in bed all but 3 hours a week. That's long enough for a shower a week, and bed baths the rest of the time.
As for packing, I have found that Hydrofera Blue is EXCELLENT! Its a bactrostatic, and highly recommended by my husbands wound doctor.
Boredom?? Grand Turismo 4 and a Playstation with wireless nerf control!!!...lol
There are allot of other areas I can touch on this subject, but there will never be enough room. Anyone that is curious is welcome to ask, and any suggestions are welcome.
#24
Posted 28 February 2007 - 07:10 PM
Why did the doc say a flap was not a solution for your husband? Same question to you ladysmack. Why no flap?
And the cliniron bed is magic. You litterally float. Lay on your back and no need to turn except for comfort.
Keep us informed and let us know if we can help in any other way.
BRETT
Morality, like art, means drawing a line someplace. --Oscar Wilde
#25
Posted 28 February 2007 - 07:24 PM
brackman22, on Feb 28 2007, 12:10 PM, said:
Why did the doc say a flap was not a solution for your husband? Same question to you ladysmack. Why no flap?
And the cliniron bed is magic. You litterally float. Lay on your back and no need to turn except for comfort.
Keep us informed and let us know if we can help in any other way.
BRETT
He has had 2 flaps done, the second poorly done, and neither of them worked. Osteo has been the enemy here. That is the worst thing you can get as you know. His whole hip we have been told is infected, although, the last time they went in they found no draining bone. He has had his left hip removed and part of the left femur removed. That was done about 3 years ago. It messes up his weight distrubution and Transfers and hindered tremendously. As you said, time to find a new doctor, so we did. The best course of action for us now is to patiently wait, if there is such a thing. We went last month for his last surgery, and we thought that right hip would be removed. It was not!!! yea!
#26
Posted 28 February 2007 - 07:41 PM
Although Christopher Reeve has died with blood poisonings, MRSA and Staph can be cured. Look into the phages links.
http://www.woundcarecenter.net/
This post has been edited by LadySmack: 28 February 2007 - 08:15 PM
#27
Posted 28 February 2007 - 08:34 PM
It sure does sound like you and your husband have been through a lot. I hope he knows how lucky he is to have a wife like you. I wish I had one as loyal. Hell, I just wish I had one
I hope your luck changes quickly.
Brett
Morality, like art, means drawing a line someplace. --Oscar Wilde
#28
Posted 28 February 2007 - 10:50 PM
#29
Posted 01 March 2007 - 12:01 AM
brackman22, on Feb 28 2007, 01:34 PM, said:
It sure does sound like you and your husband have been through a lot. I hope he knows how lucky he is to have a wife like you. I wish I had one as loyal. Hell, I just wish I had one
I hope your luck changes quickly.
Brett
Brett,
Just because you are in that chair does not mean you don't deserve love. You always remember that. She is out there.
Secondly, please refer back to my last message......My husband has tested positive for it twice. Since the phages, every test since then has come back negative. I know what the facts tell me, and I also know what the books tell all of us, but there is hope.....isn't it worth a try? Was for him. Check it out....
And, the same wish for you, I hope your luck changes quickly, and for that, the others reading all this.
LadySmack
#30
Posted 01 March 2007 - 12:12 AM
ziggy, on Feb 28 2007, 03:50 PM, said:
The best I can tell you at this point is to consult your doctor, EXPECIALLY if you have wounds. He will know the steps you need to take. I hope she is a very clean person. Handwashing is a must no matter if MRSA, staph, or whatever is a factor or not. Your doctor may have concerns with this, so I would most definately ask, he/she might want you to make sure she changes her clothing each time she does her visits. I would sure ask that of them, but I'm sometimes an overly cautious person....so that's one womans opinion.
Best of luck.
LadySmack
This post has been edited by LadySmack: 01 March 2007 - 12:14 AM

Help












