Stage II pressure sore on rib cage, please help.

[Quadzila@optonline.net]

Hello everyone,
For the past couple of months, I've been experiencing a few different SCI related health problems and I'm hoping I can get some advice from the group. FYI, I have a tethered cervical cord that doctors are very reluctant to operate on. This is causing me progressive weakness and other health problems. I'm usually ok at problem-solving but I've been at my wit's end lately due to a lack of sleep, pain medications and some depression. I have a few ideas and questions I was hoping to run past the group.

The most serious problem is a stage 2 pressure sore on my right rib cage. The open area is approximately one inch while the rest of the sore is approximately 2 inches.. It went from stage 1 to stage 2 a couple of days ago. It's hard for me to keep pressure off that area as I have a severe scoliosis and there is a lateral support on the right side of my chair that helps prevent the scoliosis from getting worse. That lateral support is covered with mini Roho but I'm still having problems with pressure sores. Also, when I do my bowel routine, I have to lie on my right side for approximately 3 hours every morning. I am also much more comfortable sleeping on my right side but I am able to sleep on my back if I really have to.

I stopped using the lateral support while in my chair but still need some ideas on what to do regarding my bed. FYI, I did order a Rest brand air mattress but because of covid-19, I won't be able to get it until the end of January. The mattress I'm using now is an old box spring with a 4 in. fiberfill mattress topper. I was thinking in the meantime of purchasing a 3 or 4 inch foam mattress topper and cutting a small hole, maybe around 8 inches, in the area where my pressure sore is. Perhaps even cutting the sheet where the hole is to keep total pressure off. Anyone else in the group have a similar pressure sore? What steps did you take to treat it?

Would Silvadene help it heal any faster or should I just keep it dry?

Thanks in advance for any info you can provide. I'm also having problems with my bowels and bowel routine, if you have any advice, please see my other post regarding that. Thanks!

Dan G.

[SCI-Nurse]

Can you describe what it looks looks like?
No Silvadene is for burns, silver helps prevent infection but you need to clean it 1-2 times a day with wound cleanser or normal saline. if truly a stage 2 and with your pressure issues/positioning- hydrocolloid or Medihoney w/ foam dressing should be best. If you order a mattress you can get a memory foam overly that is 1.5 to 2 inches and it should work better than regular foam .I think Amazon or Walmart have the best prices unless you can get the overlay paid for by insurance.

Need specifics on Bowels- 3 hrs. is long.
My first recommendation is- Stool needs to be formed but not hard, (Bristol #4) adjust stool softeners and drink water &/or use Miralax ( PEG) daily, Enemeez (Enemeez plus if have AD or hemorrhoids or rectal pain) or Magic bullet), dig stim x 3 if needed.
Try free samples of Enemeez contact company- www.enemeez.com for samples.
Reserve other laxatives or larger volume enemas for the occasional rescue. ex. you hate good food (crap) for holidays and now constipated- good time to use but not all the time.
CWO

[Quadzila@optonline.net]

Hello SCI nurse,
sorry for the late reply, the wound is about 1 inch wide, hard to see how deep but nowhere near the bone. it's been scabbed over for a few days now and is slowly getting better but I ordered a small tube of Medihoney to help it along. I used Medihoney around five years ago and it worked great, thanks for mentioning it. Regarding the bowel routine, 3 hrs. is the time from setup to clean up. Cleaning up takes the longest, but I could probably cut the whole routine down to 2 hrs. by getting some help from my CNA. It's usually a little under 30 minutes after inserting the bullets for me to have a BM. The stool ranges from Bristol #2 to Bristol #4. Thanks again!