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Thread: Pressure sore advice wanted

  1. #1

    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. #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; 11-19-2011 at 03:05 PM.

  3. #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.

  4. #4
    Quote 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.

  5. #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?

  6. #6
    Senior Member
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    New Mexico
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    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.

  7. #7
    Senior Member
    Join Date
    Apr 2011
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    San Diego, CA, USA
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    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.

  8. #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

  9. #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.

  10. #10
    Quote 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?

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