Recipies for avoiding/treating sores/skin issues

[KyleP2112]

What about a round possibly surface fungal issue?

[SCI-Nurse]

What about a round possibly surface fungal issue?

Cutaneous candidiasis (skin yeast infection) are fairly common in moist folds such as under the breasts in women, in the groin, armpit, or between the thighs. They are often associated with incontinence of urine or stool, or excessive sweating. They are more common in people with diabetes, so if you have these often, you should be screened for this chronic disease.

As far as treatment, if the skin is dry and scaly, a antifungal cream (Nystatin) may be best. If moist, then an antifungal powder (Nystatin) may be better, but care should be taken to not let it cake (it should be only lightly dusted in place and any excess brushed off). For severe infections, a short course of oral antifungal medication (Diflucan) may be needed. This requires a prescription from your PCP.

http://emedicine.medscape.com/article/1090632-treatment

(KLD)

[Sit-N-Fly]

I mostly lurk on this forum, but thought I would contribute my experience with my first sore. I'm starting my 25th year as a para and this is my first sore that required treatment. I've had bruises, a few red spots on ankles, but this is the first open wound. Aging with SCI is not a great experience and increased danger of skin issues is an unfortunate reality. I believe I caused the sore by slightly missing a transfer and scraping my butt on my handcycle. The sore was right above the end of my tailbone in my ass crack. I really couldn't see this area with a mirror. It probably had been there a while before I noticed the oozing. Nasty, I know, but be aware that you can't see everything with a mirror.

Anyway, to say I was pissed off would be a major understatement. Damn it, I take care of myself, this isn't supposted to happen! I thought about home treatment, but reluctantly went to my primary care doc and he referred me to the wound care clinic. They said I caught if before it became a code red, which was a relief. They cleaned it thoroughly and then dressed it with a product call MediHoney. They also use a pad called a Mepilex Border with Safetac technology. I would recommend both of these products. Since the wound was not on an area that I sat on, I was able to mostly continue with my everyday routine, but did have to get back in bed on my side for a few hours every day during the first couple weeks. I'm pretty active and this was a depressing turn of events. The dressing was changed after every shower (every other day) and I was able to lightly cleanse the wound using baby shampoo.

I'm now six weeks into treatment. I no longer have to use a dressing or pad and the wound is nearly healed. Knock on wood and thank my lucky stars that I caught the damn thing early. So, here are my lessons learned: 1) Plan each transfer and take a breath before hoisting yourself (or being hoisted) anywhere, 2) Acknowledge that you and your skin are getting older and increase your vigilance, 3) See a doctor immediately if you have an issue, even if you hate going to the doctor, and 4) If you can't see everywhere with a mirror, at least feel around for a rough spot, wetness of any kind, or a hot spot. Get someone's help, if you have that option.

I might post pictures, if anyone is interested. They are just pictures of some guy's ass crack, but they do show progression from discovery to healing.

Be vigilant, do weight shifts religiously, and watch your transfers!

[zagam]

Any solution for walkers who sit to work

A guy here in Austin tells me he had his butt bones shaved to get rid of the high points.

I second "are you serious".

You should require defect free seat design. I.e. uniform pressure and zero shear force.

Zero shear can be achieved with a squeeze angle of about 80deg (according to Glide Rehabilitation Products). Having an acute angle prevents you from tending to slide out of the chair and also provides better stability for those with limited trunk control so that you don't stack and break bones. The back also supports you so there is no shear force. The whole thing is reclined so that you fall back in to the char rather than slump forward.

Cushions can only work if you first eliminate shear. Then there are cut-out, memory foam, gel and pneumatic ones.

The best ones are the ones that provide uniform pressure without needing expensive customisation, are durable and reliable.

I have a Trulife Easy cushion in chair, but it only works when I use it! However, I do get spaz on it if I am wearing extra layers.

The Trulife Easy has gel inside memory foam in low friction HDPE bag with stretchy cover to reduce shear force.

The problem is I rely on DermaBrief when I am not in the chair and it does not work that well and it is the thin tissue over coccyx (tail bone) that goes bad. My office chair does not have a cutout for the coccyx.

GP told me to go for walks regularly. I.e. stay off my butt.

There is some open literature on foam cut-out and other designs that I have read:

"Clinical trial of foam cushions in the prevention of decubitis ulcers in elderly patients", REMY LIM, M .A., ROBENA SIRETT, B .Sc., TALI A . CONINE, D .H .Sc ., and DAWN DAECHSEL, B .S.R., O.T.

"PRESSURE REDISTRIBUTION IN WHEELCHAIR CUSHION FOR PARAPLEGICS: ITS APPLICATION AND EVALUATION", A. G. KEY, M.B., ChB., M. T. MANLEY, B.Sc., Ph.D., C.Eng., M.I.Mech.E.2 and E. WAKEFIELD, Dip.Physio.

"Seat Cushion Selection", Martin W. Ferguson-Pell, PhD.

[jck77]

For the person who asked about the rashing and skin breakdown under his wife's breasts and in her groin, I have that problem sometimes and what works for me is to wash that area at least once a day with vinegar or vinegar in some water. The smell doesn't stay but it keeps those areas from getting rashy, smelly and sore. It also clears up a rash but it burns like the devil for a little while. I'd rather prevent the rash. But it will clear up a rash overnight.

Another good remedy for rashes in those areas is to use plain yogurt applied to the skin after washing and drying it.

Coconut Oil works well, too.

[cklovesflowers]

This is extremely helpful. I think I am confused though.

*Question - As a woman, I am getting heat rash on the inside of my legs. Then my groin. and redness under my breasts, ( I never thought about that.). so, powder? or Desitin cream would be better? or udderly smooth? Will the powder help better with moisture?

I was using hydrogen peroxide and then anti-biotic ointment in a couple of areas.

My PT is looking at the Comfort Company Vector Cushion, high profile. I guess upon the skin integrity check I was already red in the wrong areas and one hip sits higher than the other.

My PT said 1 minute ever 10 minutes pressure relief would be excellent if I would get into that habit.

*often I use pure lavender oil for small bug bites, scrapes etc. I am amazed how well. one tiny little drop. but I would consult a naturopath.

*I am an avid moisture freak. I use a Dial extra dry skin/shea butter lotion, I use coconut oil mixed with a couple of drops of lavender oil, sometimes I use a vitamin E oil/cream. I use pure Aloe Vera if my legs are inflamed as it cools too. Depends on what I have in the moment. or I use what is close throughout the day. Next to the bed. side table. etc. I use it throughout the day.

[SCI-Nurse]

I am not clear on some of your questions. Here goes for my take on these:

This is extremely helpful. I think I am confused though.

*Question - As a woman, I am getting heat rash on the inside of my legs. Then my groin. and redness under my breasts, ( I never thought about that.). so, powder? or Desitin cream would be better? or udderly smooth? Will the powder help better with moisture?

For either men or women with groin or inner thigh rash, you need to determine if it is actually "heat rash" (small punctate raised rash) or a fungal rash (irregularly shaped patches that are smooth, usually). For both men and women, I strongly encourage a routine of at least once a day (twice is better) getting into a frog position without any lower body clothing on, washing the area with gentle soap and water, rinsing well, patting dry, and then staying in the frog position for about an hour. Some use a small fan or hair dryer (on cool setting) to aid in drying the area in this position. For prevention, use of something like Interdry fabric, which both wicks moisture away and inhibits the growth of bacteria and fungal with silver, can be very helpful. Fold a piece into place in skin folds (pannus, groin, under breasts, etc.) after doing the washing/drying above, and after applications of any antibiotic or fungal creams or powders.

I was using hydrogen peroxide and then anti-biotic ointment in a couple of areas.

Avoid the use of hydrogen peroxide (H202). It actually kills the good cells like fibroblasts that are trying to heal wounds, and has no real benefit. Antibiotic creams are helpful only if you have a bacteria infection (won't help with fungus).

My PT is looking at the Comfort Company Vector Cushion, high profile. I guess upon the skin integrity check I was already red in the wrong areas and one hip sits higher than the other.

Did you have computerized interface pressure studies done on a variety of cushions? This is a much more accurate way to determine which cushion provides you the best pressure reduction. Also, that cushion does not really do a good job of either heat or moisture dissipation, which can be factors in both rashes and pressure injuries.

My PT said 1 minute ever 10 minutes pressure relief would be excellent if I would get into that habit.

That is a good recommendation. What method are you using? How are you developing that habit?

*often I use pure lavender oil for small bug bites, scrapes etc. I am amazed how well. one tiny little drop. but I would consult a naturopath.

I would not recommend this for pressure injuries.

*I am an avid moisture freak. I use a Dial extra dry skin/shea butter lotion, I use coconut oil mixed with a couple of drops of lavender oil, sometimes I use a vitamin E oil/cream. I use pure Aloe Vera if my legs are inflamed as it cools too. Depends on what I have in the moment. or I use what is close throughout the day. Next to the bed. side table. etc. I use it throughout the day.

It is good to keep skin moisturized, but don't overdo it. This can lead to moisture related skin breakdown.

(KLD)

[Ajstevens]

avalon patches and reganerex will get rid of any sore. Dealt with one for 6 months last summer and just fixed one this week right on tailbone.
The one last summer I went to wound clinic and they always wanted me to keep it "moist" well that didn't work to well, stinky and took FOREVER....did my own thing, regenerax and avalon and it was gone. Have had 3 in the 6 yrs I've been hurt and there's nothing worse then laying around doing nothing, drives me F'ING NUTS

[cklovesflowers]

thank you. KLD,

1) its heat rash. but that is very good information I am going to put into memory.

2) I will stop using Hydrogen peroxide, I had no idea. I was using the antibiotic ointment in case kind of thing.

4) . never thought of the overdo on lotion.

5) The vector cushion. hmm. and no, I am just beginning this journey. Don't know if that is something we will do???? or if I have to ask. This is one cushion he said, and they happened to have one there at the place and I had seen it online. low maintenance. Interesting about no heat dissipation. That is a concern. I will ask about the mapping. and other cushions.

6) About the 1 min every 10 - I am not able to hold myself up for one minute by my arms. I am using combination of holding myself a few seconds. but mostly scouching (is that a word) side to side. does that make sense? so one side gets relief then another. counting in my head. Right now I tend to sit in a side swept position I am told? So I have to work to get relief off the side that get a lot more of pressure. My new chair with a proper cushion and back will help me be in a better position/posture etc. My PT said. Honestly, developing the habit is a great question. All of it is. At the moment, just attempting to notice time although I thought I might set an alarm on my phone. I set alarms for everything else. Meds, empty bladder, etc. So, why not add pressure relief to the mix.

7)So, simply washing and air dry. and the special fabric. makes sense. thanks.

Things to write down for my next Dr. appt.

C

[SCI-Nurse]

A side-to-side weight shift can be effective. Just be sure to have someone spot you when learning the position to be sure that you clear your ischium completely on each side, and hold for 1 min. on each side if possible. Most people who do push up weight shifts only hold them for 15 seconds, which is fine if you do them at least every 15 minutes.

You have to learn to be your own advocate. Tell the PT who is fitting you for the cushion that you want to have interface pressure studies done on several different cushions. If they are really expert in SCI/D seating, they should have advised this from the beginning.

(KLD)

[SCI-Nurse]

avalon patches and reganerex will get rid of any sore. Dealt with one for 6 months last summer and just fixed one this week right on tailbone.
The one last summer I went to wound clinic and they always wanted me to keep it "moist" well that didn't work to well, stinky and took FOREVER....did my own thing, regenerax and avalon and it was gone. Have had 3 in the 6 yrs I've been hurt and there's nothing worse then laying around doing nothing, drives me F'ING NUTS

For pressure injuries (not rashes) the wound does need to be kept moist, not wet. Regenerex is a stem cell therapy and very expensive, and requires a prescription. Not sure what you are referring to re: "avalon". Perhaps you mean ALLEVYN foam dressing?

(KLD)

[Ajstevens]

For pressure injuries (not rashes) the wound does need to be kept moist, not wet. Regenerex is a stem cell therapy and very expensive, and requires a prescription. Not sure what you are referring to re: "avalon". Perhaps you mean ALLEVYN foam dressing?

(KLD)

Yes, those. Thanks. That has been my best to cure a sore. Also you agree for pressure injuries it is better to keep moist ? I just couldn't get it to heal while staying moist. Seemed to stay at damn near a stand still. My insurance covers regenerex. Dr's fight for it thank god

[SCI-Nurse]

Fibroblasts (the cells that fill in an open pressure injury) are killed by drying, so if you keep the wound dry all the time, and uncovered, it will inhibit the growth of fibroblasts.

(KLD)

[AlexAgain]

For prevention - check your toilet seat or whatever you sit on to do your bowel routine. After fiddling with my seating of my wheelchair for a couple years with no good results, I discovered it was my toilet seat causing the pressure.

For treatment - I healed my pressure sores incredibly fast by using low-level laser treatments.

[carocole90]

It took some time for me to read this but really I didn't fed-up even for a while..such an interesting as well as helpful post. Thanks.