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    Pressure sore advice wanted

    Found out yesterday that I have a sore on my butt. My regular doc wasn't in, so I saw a different doc. She was fresh out of med school and didn't know anything. She referred me to the wound clinic. I called them and they can't see me until November 30th. Any advice on what I can do between now and then?

    p.s. I can't see the sore, but I'm told it is a sacral pressure sore. It's about the size of a quarter. Red on the outside, and draining some yellowish brown stuff from the center.

    #2
    You probably know to keep as much pressure off it as possible, and you should get a culture asap, from your description it sounds infected. Putting topical antimicrobial ointments or Vetericyn I found work to prevent infections, but they can't treat an infection and can make getting a culture more difficult. Think waiting until the 30th is taking a big risk since it's oozing, and certaily don't want it spreading into the bone. Hope this helps.
    Last edited by Craig80; 19 Nov 2011, 3:05 PM.

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      #3
      I agree with craig, if you can't use a mirror someone elce will have to dress it for you, avoid sheering when transfering if you use a chair, take a measurement and pic to monitor the stage process, if you leak urine wash and treat at once. if you have pus and a certain smell on the gauze it is probably infected. the red patches could be a sign of infection, gauze tape irritation or urine burn. remember it is important that the sore granulates and to scrap off slough with a surgical blade.

      Comment


        #4
        Originally posted by Craig80 View Post
        ...waiting until the 30th is taking a big risk...
        Waiting till the 30th is medical malpractice IMO. Shanon, you are probably infected already. It never ceases to amaze me how stupid our medical care delivery system is. If someone drops by a BP clinic at work, and they test above 180, they will all but cuffed (bad pun intended) and sent by ambulance to the emergency room. Yet a serious pressure sore can wait weeks.

        I faced the same dilemma recently. After 4 weeks of escalating referrals and having to wait another 3 weeks to finally see a plastic surgeon, I had to take action. If you go the the emergency room they will take it seriously but be prepared for some serious heart stopping moments when the bills come. Pray they take Medicare assignment and be prepared to become a pauper. I still don't know how it will all wash out. They billed $23K just for IV antibiotics alone. Medicare hasn't paid any of that.

        You are probably lucky the doc was new. Otherwise you might not have been checked. My wife has been mostly wheelchair bound for 10 years and entirely for 5. I can't remember the last time her primary care physician ever checked her skin. But why be inconvenienced with patients who are difficult to examine.

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          #5
          That's terrible. It seems like there are more and more of these stories about uncaring medical care given to SCI patients every day.

          Anyway, I am no expert here, I would probably go to the ER myself. SCI-nurse might advise.

          Do you mind if I ask how you got the pressure sore? I am paranoid about getting one myself. Was the cushion in good condition or did something go wrong with your regimen?

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            #6
            Some home care agencies provide medical care for wound treatment. I recently benefitted from this service. However 2 of the 4 wound care nurses were in training. The nurses will watch for signs of infection, and if needed (I was told) they could send off a sample to the lab. The only thing which I found to be unnerving was when they asked me how often I wanted to be seen. I requested every other day meaning Mon - Wed - Fri - Sun - Tues - Thur - Sat - Mon -. It required a minimum of 2 nurses since many do not work weekends.

            I insisted that a nurse take pictures once a week to watch the progress. Midway through my treatment the progress stopped. The nurse than had to try different wound care products.

            Perhaps you can call some local agencies and then have your doctor fax them a referral.

            Comment


              #7
              This is heart rending to see how our country is going.

              My thoughts are take a picture so you can see for yourself what it looks like.

              The squeaky wheel gets the grease. Start squeaking. Loudly. Better to be a total PITA than to suffer with this maltreatment.

              I agree that a culture is first and foremost. Does not require the wound clinic. It could have been done in your primary care doc's office.

              Good luck. Don't be shy.
              T4 complete, 150 ft fall, 1966. Completely fused hips, partially fused knees and spine, heterotopic ossification. Unsuccessful DREZ surgery about 1990. Successful bladder augmentation using small intestine about 1992. Normal SCI IC UTI problems culminating in a hospital stay in 2001. No antibiotics or doctor visits for UTI since 2001: d-mannose. Your mileage may vary.

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                #8
                You need to stay off of it and wash it with sterile normal saline twice a day. You can cover with saline moistened gauze and optionally cover with Tegaderm or you could cover with Duoderm or Hydrocolloid agter cleaning and you can do this once a day.
                If the wound bed has necrotic tissue like yellowish or brownish slough or eschar then you would need Santyl( apply entire wound bed nickel thickness) or something to help remove that(debride). After applying the debrider you should cover with a moistened gauze dressing and can cover that with Tegaderm.
                If it looks infected you can apply a topical antibiotic first then the debiding agent then the dressing.
                CWO
                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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                  #9
                  Thank you all!

                  I was surprised when she said I couldn't come in until the 30th. I thought they'd want me there asap.

                  MSspouse, it wasn't the doctor who discovered it. It was me. I can't see it, but as I was pulling up my undies last Thursday, I noticed some wetness. So I felt back there with my finger and could feel a change in skin texture. I wiped it with toilet paper and got a little bit of yellowish stuff on it. So I called my doc the next day, she wasn't in, and I had to see this other doctor. After the appt I went home and immediately called the wound clinic and she said I couldn't be seen til the 30th. I said, "I don't think this should wait that long" and then she gave me the number to a different wound clinic. I called them but it was already 4:30 and they had left for the day. So, I will call this other clinic first thing Mon morn. If they say they can't see me on Monday, Tues, or Wed of this week, I'll be persistent.

                  As for how I got it... About a month ago I had a cold and I decided it might be better to sleep propped up on a few pillows. Then after my cold was gone, I continued sleeping that way because I thought it was comfortable. I'm pretty sure that is what caused the sore. So now I'm sleeping flat on my back. I can't sleep on my side because it hurts my shoulder. I can't sleep on my stomach because it hurts my back.

                  The good news is that I don't think I'm sitting on it when I'm in my chair. I put my finger on it while sitting, and I don't think there is any pressure there.

                  Comment


                    #10
                    Originally posted by peterf View Post
                    I agree with craig, if you can't use a mirror someone elce will have to dress it for you, avoid sheering when transfering if you use a chair, take a measurement and pic to monitor the stage process, if you leak urine wash and treat at once. if you have pus and a certain smell on the gauze it is probably infected. the red patches could be a sign of infection, gauze tape irritation or urine burn. remember it is important that the sore granulates and to scrap off slough with a surgical blade.
                    Peter, why is it important that the sore granulates?

                    I don't leak urine, and I have a colostomy, so that's good. I had major back surgery 2 years ago though, and I often have a problem with sweating in my lower back.

                    Although there does appear to be pus, it is odorless. Maybe it isn't pus, maybe it is slough?

                    Comment


                      #11
                      Just read this online:

                      Necrotic tissue is dead tissue, which usually results from an inadequate local blood supply. Necrotic tissue contains dead cells and debris that are a consequence of the fragmentation of dying cells. Necrotic tissue changes color from red to brown or black/purple, as it becomes more dehydrated. Finally, it forms a black, dry, thick, and leathery structure known as eschar. This can be seen in a wide variety of wound types, including burns and all types of chronic wounds. In contrast, slough is a yellow fibrinous tissue that consists of fibrin, pus, and proteinaceous material. Slough can be found on the surface of a previously clean wound bed and it is thought to be associated with bacterial activity.[37] The accumulation of necrotic tissue or slough in a chronic wound is of major clinical significance, because it is thought to promote bacterial colonization and prevent complete repair of the wound.


                      So I guess I don't have necrotic tissue, but it does sound like I have slough. And it sounds like one cannot have slough without infection. Which means it is infected.

                      It's best to remove that slough regularly I assume? Just with a wet washcloth?

                      Comment


                        #12
                        There are debriders (like Santyl mentioned above) that can remove that. Unfortunately it's usually a wound care nurse/doc who can only order that and have experience with it.

                        Emerge should have a wound care specialist that they can call if you're really stuck? Have someone swab it for a culture and start on antibiotics if need be. Maybe it's time to switch to an overlay mattress? This is the unpredictable part with aging with paralysis - the needs change suddenly and then we have to adjust. It's usually something like this that comes along to let us know ...

                        Good luck and keep us updated - good you caught it early! I have a small spot that sounds similar myself from urine leakage 'pre-surgery' so I'll be turning my attention to that dime-sized spot on Monday with a homecare nurse. Mepilex border is excellent for small spots on the rump as it's waterproof and keeps the moisture in (or duoderm I guess if your skin can handle it - mine can't).
                        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
                          Shannon, STAY OFF OF IT. Sorry about the caps but that is the best thing you can do right now. Take my advice. I am currently laying here in a crappy rehab hospital. I have been here for a week and will be here another 4 weeks anyway. I also just spent 1 week in the hospital after having a small ischial wound sewn up for the second time in a year. So I can kiss 8 weeks of my life goodbye and hopefully I will have a good outcome from the surgery. After 8 weeks I can start sitting up for 5, 10, 15 minutes, etc. each day. Totally sucks...and my wound was small, shallow, clean and not draining.
                          Arrange for some help to come to your house so you can stay off the wound. I'm telling you...pay a little bit now or pay big time later.

                          Comment


                            #14
                            As Smokey says STAY OFF IT !!!! Get an alternating air mattress.I did 6 months by listening to the wrong advice....

                            Comment


                              #15
                              Pressure Sore Won’t Heal? Try This
                              Magnets are powerful wound healers if used correctly. Ordinary hardware store magnets will not do anything for wound healing due to their lack of strength and shape. And, only one side of the magnet will cause any healing; the South side. The North side of the magnet will cause additional damage, so be aware and be careful.
                              The first step is to look at the location of your wound and measure its size. If it is round, then a round magnet would be appropriate. If your wound is oval, oblong or elongated, then a rectangular magnet would be a better fit. If your wound is in a fold or crease of skin, then a rectangular would be more appropriate. The idea is to select a magnet that is at least 20-25% larger than the wound. Reasoning—the center of the magnet has the most strength. The outer edges have the least strength. Second, the magnetic field will wrap around the outsides of the magnet and the wrap-around portion of the magnetic field is not helpful for wound healing. Same with the North side of the magnet.
                              Neodymium magnets are the world’s strongest magnets. Increasing the size and changing the thickness of the magnet will increase the strength. You should look for a magnet that is between 700 and 3000 gauss. For comparison purposes, the earth’s magnetic field strength is about ½ (0.5) gauss.
                              Neodymium magnets are very powerful and should be used with caution, especially around electronics and pacemakers. Start off by reading and understanding the following limitations/cautions. http://www.kjmagnetics.com/safety.asp This link is from just one company and there are probably others. This link may answer some of your questions. http://www.kjmagnetics.com/FAQ.asp
                              If you decide to experiment and want your pressure sore to heal a lot quicker, consider either a flat disc magnet or a rectangular magnet that is magnetized from the top flat surface through to the bottom surface (axially magnetized). Buy only one magnet and choose the correct size and shape depending upon your wound. The flat ones come in 1/16” thick, 1/8” thick, and even thicker. These links show various choices. http://www.kjmagnetics.com/products.asp?cat=10 for round discs. For example, DX21 or DX22 are shown toward the bottom and are 1 1/8” in diameter and 1/16” or 1/8” thick. The DX21 is 735 gauss, the DX22 is 1432 gauss. http://www.kjmagnetics.com/products.asp?cat=11 for rectangular magnets. BX062 or BX081 are two examples of rectangular magnets that could work. The pictures show each magnet next to a penny for comparison purposes. Click on the magnet number for individual magnet specifications and strengths.
                              Neodymium magnets may not come marked as to the north side or south side. Even if you buy a magnet and it is marked, do not trust the markings. Magnets can be magnetically charged through the top and bottom surfaces or through its edges (e.g. cylinder or bar). Look for a magnet that is axially magnetized—from the top flat surface through to the bottom flat surface. DO NOT get a magnet that is magnetized from one end/edge through to the other end/edge, e.g. a cylinder shaped magnet.
                              To determine the correct healing side of the magnet, the South side, make sure you have a green magic marker handy along with a piece of light string or thread. Assume that you have a round disc shaped magnet. Tie your string around the magnet where the knot is next to the thinnest edge. Suspend the magnet by holding the string above the magnet. The SOUTH side of the magnet will rotate until it faces the southern direction of the earth when the magnet is stationary (not rotating). Mark the southern face of the magnet with the green magic marker. Turn the magnet any direction while holding the string and the now marked side will always face the southern direction of the earth when it stops rotating (stationary position). Repeat 4-5 times to ensure that the green marked side of the magnet repeatedly faces the southern direction of the earth in a stationary position.
                              With magnet in hand and correctly marked on the South side, use a thin film of antiseptic cream and spread on the wound. Cut a thin piece of surgical gauze the size and shape of the magnet. Place gauze directly on the wound. Then place the South side of the magnet facing the gauze and wound. DO NOT make a mistake here!! Use a Band-Aid or surgical tape to attach and secure to the surrounding skin. Check your wound twice per day. You should see that the wound has healed over in 5-7 days. A single magnet cost about $3-7. The magnet can be used for 8-9 days straight.
                              Store the magnet in a wooden box. Keep it away from other metal objects. If the magnet gets stuck to a piece of metal, you may not get it pulled off without breaking it.

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