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stage 4 pressure sore getting worse

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  • stage 4 pressure sore getting worse

    so ive had a stage 4 pressure sore for about 6 months ever since i found out i had osteo in my pelvis and myositus in both thighs and pelvic muscle. the sore was healing really well but while i was hospitalized for the infections (which were really bad) the sore got worse. when all the necrotic tissue finally came out about 2 months ago we realized there was severe undermining. i started in on VAC therepy about 6 weeks ago and while some of the undermining got better, places that had none are now severe. in addition to the undermining ive developed tunneling. the places that are getting worse are also the spots i relieve the most pressure off of so i dont understand how they can get worse without pressure or shear.

    the point of me posting is i dont know what really to do. i have an appointment to get pressure mapped in my chair (tho my cushion is a ride and it doesnt even come close to the wound) and hopefully get a perscription for a new bed. also ive been trying my best to stay off the wound and not create shear. i eat alot and the last time i was checked my albumin was in the mid 3's, they are hoping for 4. i take a fair amount of vitamin A, zinc, D3, C and l-arginine. i get plenty of fluinds and have very, very minimal spasms.

    HELP.....i dont want surgery but at this point im considering it. im really tired!!
    "Impossible is Nothing" - Adidas Slogan

  • #2
    Hi,

    Is your sore the place where your osteomyelitis is?
    If you have osteomyelitis, are you on antibiotic therapy? Bone infections (osteomyelitis) do require antibiotic therapy.

    Regardless, you should not be sitting on a stage 4 sore and you should keep all pressure off or it will not heal well. The undermining could be due to your continued sitting and the osteo. A clinitron or dolphin bed could help but if you you are on another mattress, make sure you are turning and staying off the sore.

    You are doing the right things with your diet and intake and your albumin is acceptable.
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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    • #3
      the osteo was originally diagnoised(sp) in the anterior illiaca crest and bone was removed. they then treated me imperically with 6 weeks of iv vanco and oral cipro, following it up with 4 weeks of another antibiotic that starte with a d and killed my stomach. when i was off them the necrotic tissue fell out and the bone was visible. they tested the bone of the sacrum and i had strep B. so now im about to finish a 6 week course of oral levaquin.

      as far as not sitting on it...the sore is on my sacrum and doesnt get sat on. my physiatrist is not worried about pressure in that spot while sitting(fyi...he is the lead VA physiatrist in washington, an associate proffessor at UW, and a main physiatrist at Harborview Medical Center in seattle). now my shoulders are a wreck from laying on them and my upper back is in severe 7ish pain from my spinal fusion.
      "Impossible is Nothing" - Adidas Slogan

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      • #4
        I would 'ask' for IV antibiotics again. 12 weeks worth to kill it ... are you seeing an infection specialist as well?
        Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

        T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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        • #5
          i see 3 infectious docs, 1 physiatrist, 1 physical therapist, 1 plastic surgeon, 2 wound specialist nurses, nurses come in and change the VAC 3 days a week and my PCP... im on antibiotics now which will have been almost 4 months this year and they said(the 3 id docs) the oral levaquin is the best for bone penetration with the strep B infectiion. problem is half my doctors are in my town the others 100 miles away.
          "Impossible is Nothing" - Adidas Slogan

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          • #6
            I think they're wrong but I leave that up to you and the smart people.

            IV Antibiotics are best for bones because they don't lose their strength while travelling through the gut, since they go right to the blood stream.

            Perhaps I'm wrong? It happens, lol!
            Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

            T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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            • #7
              all i kno is my veins have been tortured by iv antibiotics, not to mention im getting to the point of them not working. because of my level of activity i blow iv's out fast and picc lines have a cascading effect of: no working out, muscle atrophy, pain then finally depression.

              in all honesty im hoping a new bed that wont screw up my shoulders or place excessive pressure on my spine will be the solution.
              "Impossible is Nothing" - Adidas Slogan

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              • #8
                they said(the 3 id docs) the oral levaquin is the best for bone penetration with the strep B infectiion.
                all i kno is my veins have been tortured by iv antibiotics, not to mention im getting to the point of them not working.
                I've never heard of any bacteria that's sensitive to oral antibiotics but resistant to IV antibiotics.
                It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.

                ~Julius Caesar

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                • #9
                  i never once said it was resistant to iv antibiotics. all i was saying(without saying i suppose) is the second i get an iv its over. no more veins. the doctors cant explain why but it usually takes 2-3 iv nurse to be able to start one. and im the kind of guy that has garden hoses for veins.
                  "Impossible is Nothing" - Adidas Slogan

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                  • #10
                    Ah, pronoun trouble. (Credit: Bugs Bunny)

                    The sentence structure indicates that "them" (the things that are not working) refers to IV antibiotics, but you meant the actual IVs.

                    Thanks for clarifying that.
                    It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.

                    ~Julius Caesar

                    Comment


                    • #11
                      I had a sore there once, on my sacrum, and I did all that wound vac and antibiotics. It was huge, you could practically lady your hand in it flat. It was huge. It took me a little while but I finally found a doctor who would close it. We ended up taking skin from somewhere else, and muscle and all that, and putting it there. You're right about sitting up. It's better than laying down on that sore. Unless you're laying completely flat all the time. Or on your sides which I can't do because my shoulders can take it. I had what you're talking about done a couple of years ago and I still have to be careful of it. Just keep yourself pretty much flat and it will eventually send you were someone else will do it for you. Good luck getting it done.
                      C-5/6, 7-9-2000
                      Scottsdale, AZ

                      Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

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                      • #12
                        I will blow out an IV in my wrist as well ... because I'm use my arms all the time for movement. You've had the PICC line I assume - the one under your underarm where the vein is bigger?
                        Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

                        T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

                        Comment


                        • #13
                          James,

                          I agree with you that if you have had iv antibiotics and the culture says that oral levaquin is sensitive, it definitely appropriate to continue with these, as your clinicians recommend. IV antibiotics are usually best initially to get things going, but if it is chronic therapy, oral meds are fine.

                          Thanks for clarifying about the ability to sit, which sounds ok if the wound is not having pressure with sitting. HOpe you continue to improve and keep us posted.

                          AAD
                          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                          Comment


                          • #14
                            thanks for the input. im just at the end of my rope. it heals in one spot then gets worse in another and this pattern has just been cyclical. the antibiotics have been working near as i can tell and same with the VAC as the tissue is healthy. it just wont close on the inside. the outside will close if we let it but we need it to stay open of course. im really considering a flap but im only 30 and flaps arent that reliable.

                            just frustrated....but ill keep going til i cant anymore(might be sooner than later).
                            "Impossible is Nothing" - Adidas Slogan

                            Comment


                            • #15
                              Why do you think flaps aren't reliable? I had one on my coccyx area when I was 15 (I'm 37 now) and never had another problem again. It's held all this time (plus I switched to a Jay Active cushion from foam all those years ago).
                              Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

                              T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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