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  • Need help with new cushion and new skin issue

    Hello all,

    I'm having skin issues on and around my genitals and I cannot figure out why. I spoke with my doctor and he is clueless. They are not in an area where pressure wounds normally show up. I have a Roho Quotro cushion and a tilt/recline Pride power wheelchair. No matter how many weight shifts I preform throughout the day, my skin opens up on either side of my genitals. I'm a C5-C6 quad injured 12 years ago. This started around one year ago. I was using a regular Roho when they started and I noticed a dead spot in the cushion to wards the back. When I switched to the Quotro, it seemed to help for a little while, but they came back within a few weeks. I want to switch cushions, but I'm not sure if there is anything better than the Roho. There is one cushion I want, but it is $3000! I cannot afford that.

    Does anyone have any recommendation? I have a pressure mapping appointment scheduled in the next week and hopefully that will give me answers, but I'm doubtful.

    Any help would be greatly appreciated.

    Thanks,
    Cliff

  • #2
    Do you have any issues with too much moisture in that area? My first thought for skin splitting in that area is a fungal infection.
    Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

    I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

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    • #3
      I would suspect a fungal infection too. At the first sign of redness in that area, I apply Lotrimin antifungal powder and it does the job for me. There are several of these otc preparations available in most drug stores. There are both cremes and powders. I prefer the powder because it helps to keep the area dry.
      You will find a guide to preserving shoulder function @
      http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

      See my personal webpage @
      http://cccforum55.freehostia.com/

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      • #4
        I agree with it being fugal, being clean is important. I also had to start wearing boxer briefs instad of regular briefs to have some more "movement" for my junk, plus the elastic around the legs was leaving red irritated looking marks.

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        • #5
          Originally posted by SCIfor55yrs. View Post
          At the first sign of redness in that area, I apply Lotrimin antifungal powder and it does the job for me. There are several of these otc preparations available in most drug stores. There are both cremes and powders. I prefer the powder because it helps to keep the area dry.
          I didn't want to suggest self treating since I'm not SCI and don't know the issues there. But if it was myself, I would try an over the counter fungal medication for yeast infections/athletes foot like suggested. I get those deep cracks in the corner of my mouth which is actually a yeast infection caused by moisture (Angular cheilitis.) I lick and chew at my lips too often, combined with excessive use of chapstick in effort to keep myself from chewing or picking at my lips. I used to apply chapstick to the ulcers thinking it was chapped lips, but sealing in moisture made them very deep. Now as soon as it starts getting red and inflammed, I apply a little monistat or lamisil and it clears up fast.

          Its the same sort of thing that can happen in the genital area. Making sure to wear cotton underwear, boxers for men and so forth are good to help decrease moisture. I imagine what kind of cushion and cover would also affect it. If this is whats going on and its a long term issue, maybe something like the cushion cover with stimulite on top could help increase airflow and decrease moisture?
          Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

          I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

          Comment


          • #6
            No cotton. Cotton retains moisture.

            Use a polypropylene type material that'll wick moisture away... under armour, dri fit, etc.

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            • #7
              cotton underwear is supposed to breathe. There may be materials that are better than cotton though. I buy cheap underwear, and my options are cotton or microfiber. My microfiber ones are horrible about retaining moisture. I mostly wore them under riding breeches because they didn't show panty lines (bought them for that reason), but god they got nasty from holding on to all the sweat. When I changed out of my breeches I'd change them too.
              Last edited by ~Lin; 04-30-2012, 12:28 AM.
              Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

              I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

              Comment


              • #8
                Your cushion cover may not be breathable creating a hothouse effect leading to rash. When I buy underwear I usually get sports underwear used by bicycle riders. I don't buy unless the material is referred to as having wicking properties.

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                • #9
                  I'm not a big fan of Roho because they don't "breathe" terribly well. I use a Jay Deep Contour cushion and have had much better luck with it.

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                  • #10
                    Originally posted by SCIfor55yrs. View Post
                    I would suspect a fungal infection too. .
                    me too

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                    • #11
                      I use an anti-fungal spray also. You will notice a smell if you have skin breakdown.

                      I had a terrible problem getting clean between my legs and genitals without finger function. I bought a soft bottle brush and tied a 2 foot loop of paracord through the handle. I wrap it around both wrists and spin the brush in the middle until tight. This gives me good control of the brush and I carefully wash between my legs. I rince with the brush also. No problems or smell since spray and bottle brush.
                      C 5/6 Comp.
                      No Tri's or hand function.

                      Far better it is to try mighty things, to win glorious triumphs, even though checkered by failure. Than to take rank with those poor spirits who neither enjoy much or suffer much, because they live in the grey twilight that knows neither victory or defeat.

                      Teddy Roosevelt

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                      • #12
                        Originally posted by -scott- View Post
                        No cotton. Cotton retains moisture.

                        Use a polypropylene type material that'll wick moisture away... under armour, dri fit, etc.
                        All the ladies in the tropics were told to wear cotton underwear to prevent fungus, so I always thought it was good for that.

                        Cotton does not slide well though, so like you I wear the Under Armour, etc. The tight fit of the bicycle shorts keeps my buttocks from "flattening out" so much since I have no muscles to tighten.
                        C5/C6

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                        • #13
                          Originally posted by forestranger52 View Post
                          I use an anti-fungal spray also. You will notice a smell if you have skin breakdown.

                          I had a terrible problem getting clean between my legs and genitals without finger function. I bought a soft bottle brush and tied a 2 foot loop of paracord through the handle. I wrap it around both wrists and spin the brush in the middle until tight. This gives me good control of the brush and I carefully wash between my legs. I rince with the brush also. No problems or smell since spray and bottle brush.
                          What great ideas one can get from this site.
                          C5/C6

                          Comment


                          • #14
                            Originally posted by AntyUp View Post
                            Hello all,

                            I'm having skin issues on and around my genitals and I cannot figure out why. I spoke with my doctor and he is clueless. They are not in an area where pressure wounds normally show up. I have a Roho Quotro cushion and a tilt/recline Pride power wheelchair. No matter how many weight shifts I preform throughout the day, my skin opens up on either side of my genitals. I'm a C5-C6 quad injured 12 years ago. This started around one year ago. I was using a regular Roho when they started and I noticed a dead spot in the cushion to wards the back. When I switched to the Quotro, it seemed to help for a little while, but they came back within a few weeks. I want to switch cushions, but I'm not sure if there is anything better than the Roho. There is one cushion I want, but it is $3000! I cannot afford that.

                            Does anyone have any recommendation? I have a pressure mapping appointment scheduled in the next week and hopefully that will give me answers, but I'm doubtful.

                            Any help would be greatly appreciated.

                            Thanks,
                            Cliff
                            Cliff, I work for ROHO and I forwarded your "need help" message to the head of our Education Department, who is our lead clinical resource and lead educator. He is a physical therapist with many years of practice experience, and is also a certified wound specialist.

                            Here is his reply upon reading your thread:

                            [I]My initial thought is there is another extrinsic risk not being managed.

                            I would also suspect increased moisture or a fungal/yeast infection. So many times individuals see redness and they automatically assume it is pressure when there may be a dermatological skin issue at cause in a weight bearing area.

                            I think most of the posts are dead on in regards to a possible approach to a solution. In my mind, if the pressure imaging does NOT show increased pressure in the area, then looking elsewhere to find out why the redness is appearing is paramount. I would start with questions regarding any fecal or urinary incontinence. Then wonder about increased perspiration, and finally consider seeing a dermatologist for finding out the exact cause. The only thing I would recommend different is a lot of the self treatment recommendations . . . there are differences in treatment if it is fungal versus yeast and this can be easily determined with some testing by a trained healthcare practitioner.

                            Another thought would be are they using a hoyer lift sling and keeping that under him after they transfer him - reducing the effectiveness of the cushion OR are they taking it out from under him after he is sitting and then causing some shear or friction forces? Or are they using the new type of hoyer slings that sometime cause a lot of SKIN tension around the buttock/ groin area even though there is no direct contact of the skin? If none of the hoyer lift or other potential causes seem to be relevant in his case, would look at the pressure image of him sitting.

                            Good luck!

                            Tom

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                            • #15
                              I agree with most comments... Heat and moisture can reek havoc on the skin. Using baby powder, gold bond, etc, can help but you are postured and in a position where there is no air allowed to circulate in that area. This could be for a variety of reasons... maybe you need to raise your footrest a bit and create a little lift under the thighs, or maybe lower it a bit, maybe you have too much air in the cushion, or not enough. These are things to go over during the mapping process.
                              I am user and believer in RoHo products, but as we all know, certain products may not work for some people. Be sure to take notice of your 'junk'. Sometimes, Big Jim and the Twins can get caught up in the underwear / boxer brief. I am constantly re-adjusting, 'shifting gears', if I don't I will get light spasms, light sweat or the feeling that I need to let my legs free for some triggered spasms and completely reposition the situation.
                              Good luck with it, pressure mapping will hopefully give you some insight.
                              sigpicSCI Boot Camp

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