Pressure sore?

[singin_intherain]

Pressure sores--Can they heal? I have this irritated spot on my coccyx area that hurts like hell, makes me spasm when I shift my weight to it, feels kind of scaly/scablike, though I can’t see it. A doctor who likely doesn’t see them ever said it looked like the start of a decrubitis (or so) ulcer, recommended silvidene cream. Will this do it? I know these only as really serious, surgery indicating or worse things.

[SCI-Nurse]

Caught early (stage I or II) most pressure ulcers will heal. If it gets to a stage III or IV, more aggressive treatment, including surgery, is often needed.

First, you need to be inspecting your own skin with a mirror or mirrors daily. This way you are familiar with your normal skin and can quickly detect changes.

Secondly, if you do have a pressure ulcer (decubitus is an outmoded term) you need to see a wound care specialist, either a nurse or physician. Silvadene is an old med that lots of docs who don't know much about wound care just throw at wounds, and there are many better products available on the market.

In addition, you need to stay completely off this area (no sitting if it touches your chair, no laying on your back) until this area is completely healed.

What cushion are you using, and when did you last have a cushion evaluation? What are you sleeping on, and in what positions?

(KLD)

[lynnifer]

What do you think caused it? Transfers (rubbing on the wheel)? Mattress in bed? Cushion? Remove the cause and you're halfway there already.

[redbandit]

What do you think caused it? Transfers (rubbing on the wheel)? Mattress in bed? Cushion? Remove the cause and you're halfway there already.

karen finley is an idiot

[lynnifer]

Not sure who that is?

[etexley]

I'm not a doctor. But I have dealt successfully with some severe skin breakdown, and I've accomplished it without surgery.

There are several factors which prevent a pressure related wound from healing:

a) The circulation of your body has changed. Blood supply no longer readily gets to the area on which the wound has developed.

b) It's very easy for bacteria to colonize a pressure related wound, because there are no white blood cells getting to that area. Key give aways for bacteria are drainage from the wound, odor, or redness in the surrounding tissue.

In my experience, the only way to fix the problem of cirrculation is constant, round-the-clock pressure relief of the area with the problem. I was able to achieve this with a full-height roho cushion. Another way to help the problem of circulation area exercises on your feet. Do you own long-leg braces? Standing up for half an hour a day is invaluable. Products called "vasodilators" such as Zenaderm cream are useful for increasing circulation to the area.

The problem of colonizing bacteria is another one entirely. I've found oral anti-biotics to be relatively ineffective for dealing with this problem. If a pressure sore gets bad enough, your doctor may actually put you on IV antibiotics. Don't get to this stage.

I've found this product...

http://www.progressivedoctors.com/wound-care.html

very, very useful for bacterial colonization. It has a sugar component and an iodine component. While it turns out that sugar and iodine are considered an "old treatment" for pressure sores, this product has been an absolute life saver to me. The iodine is the disinfectant, and sugar is a vasodilator and improves circulation. And it's not $500 a tube (like some perscription creams.) I've used a really good bandage (tough skins by band-aid) to cover the area for 24 hour periods. But you have to rotate the bandage, or else the skin around it will get red from the adhesive.

Every case of a pressure sore is different ( like every spinal injury. ) The one steadfast rule is relieving the pressure. I can't feel what I'm doing to my body anymore. But it sounds like you can. The only way to really fix the problem is to CHANGE YOUR LIFESTYLE.

If you simply lay on your stomach for a month, and then go back to your old habits, it will inevitably come back again. What exercises can you incorporate into your life to improve your circulation? What seating changes can you make? Can you move around 10 times as often during the day?

Best of luck

[Rock517]

Not sure who that is?

Your signature...

[singin_intherain]

Caught early (stage I or II) most pressure ulcers will heal. If it gets to a stage III or IV, more aggressive treatment, including surgery, is often needed.

First, you need to be inspecting your own skin with a mirror or mirrors daily. This way you are familiar with your normal skin and can quickly detect changes.

Secondly, if you do have a pressure ulcer (decubitus is an outmoded term) you need to see a wound care specialist, either a nurse or physician. Silvadene is an old med that lots of docs who don't know much about wound care just throw at wounds, and there are many better products available on the market.

In addition, you need to stay completely off this area (no sitting if it touches your chair, no laying on your back) until this area is completely healed.

What cushion are you using, and when did you last have a cushion evaluation? What are you sleeping on, and in what positions?

(KLD)

Thanks.

I generally have pretty normal sensation but I had an unusual localized numb spell and suspect that's what caused it. I had more widespread flakiness that i figured was irritation from depends (though I'd never had it before, figured it was some interaction depends and numbness), and then this one spot got bad.

I have some basic foam wheelchair cushion that seems fine, and I transfer to chairs most of the day, have never had a pressure problem before. I sleep on my sides so this didn't happen in bed i don't think.

I've got one of those angled hand held mirrors but my neck mobility is not great and i can't for the life of me even align with another mirror and see the middle of my butt. Any ideas? Am I right that I needn't worry about any part of my body where sensation is close to normal?

The locaion is such that if i sit at all I can't really keep weight off; I think it might be too high to even not make contact with a donut. It is very small and angled to the crease of my butt, and I've been trying to think of something i can put around it that will stay in place and keep the pressure off. I'm picturing something like those little circles you stick around a corn on your foot, but think that might be just a little small for this. I haven't looked to see if they come bigger but would apprecite any ideas.

I'm seeing my regular primary this week. How do i know if he has any idea what he's doing and/or convince him i need a wound care specialist?

[singin_intherain]

If you simply lay on your stomach for a month, and then go back to your old habits, it will inevitably come back again. What exercises can you incorporate into your life to improve your circulation? What seating changes can you make? Can you move around 10 times as often during the day?

Best of luck

Thanks for all the info! I thought I had pretty good circulation everywhere but my feet, but trying to relieve this pressure has made me realize maybe I need to do more for my butt. I only make it to the gym (swim and machines) once a week now. I transfer a lot but i'm trying to engage my butt muscles some and do squeezes. I'd appreciate any ideas of things i can do through the day. I can stand holding on to things, but I get weary after not too long.

[etexley]

while transfers and bumps or falls may make the skin more prone to damage from pressure, a scrape is a scape, and they will heal if they don't get infected and you leave them alone.

A pressure sore is a totally different animal. It literally results from the circulation of the body CHANGING so blood supply doesn't get to the skin surface...i.e. cells don't get necessary oxygen, and white blood cells can't get there, so that the skin is prone to infection.

I ignored a pressure sort, and went about my routine for a year...and it was almost ALMOST healed from exercise. THEN it got infected. Two years later, I've ALMOST got rid of the scar and gotten it to close. ALMOST

Pressure sores are life threatening...PERIOD. Get rid of it ASAP. I remember very clearly from Jackson rehabilitation..."The best medicine for Pressure Sores is NOT TO GET THEM." If you can make it improve yourself in a month's time...good for you. Keep working at it. If you can't ? Go to a wound clinic. Just get rid of it.

[etexley]

Something else to remember....pressure sores aren't a disease of the young, exhuberant, money weilding. They are a disease of the aged in nursing homes. We are the exception to that rule!

The technology available for fixing them is just about zero...