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Thread: Popped pimple wound or pressure ulcer?

  1. #11
    I stay off of it as much as you can till it heals. Good luck
    Art

  2. #12
    I would also stay off the toilet. You can do your bowel program in bed, with plenty of chux and lying on your L side for a short period of time. You may be able to bridge that area. You may not get the results that you normally get or it may not be as quick, but it would keep the pressure off of it.

    If is is not better by Monday (tomorrow) I would definitely try to see someone about it.

    ckf
    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.

  3. #13
    Sure looks like a pressure wound to me, I personally would stay off of it until it closes completely. Duoderm or another brand of hypocolloidial dressing would be what I would use, with a spritz of Hydrocleanse before the Duoderm, and medihoney or Bactracin under the dressing. FYI Roho makes a shower/commode cushion that works great for the toilet. All one piece with opening in center. NOT the two piece toilet cover. It doesnt stay in place, I dont recommend that one. Take care

  4. #14
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    Quote Originally Posted by SCI-Nurse View Post
    If is is not better by Monday (tomorrow) I would definitely try to see someone about it.
    Thanks CKF! When you say better, do you mean relative to how it was when I posted, or all better / no longer red? As of yesterday and this morning at least, the top layer/scab has stayed on, and the ring of pink has lightened up a bit.

    Also, when talking about DTI, how does one usually differentiate between the DTI's bruising and hyperpigmentation of the skin? I definitely have some darker patches on my buttocks, but the last time I had asked about them, my doc said they were fine, so I'm wondering how I would go about monitoring in that case.

    Attaching some photos: the one with the gauze is the left cheek, without is right. I'll probably make an appointment to get checked out either way, but thought I'd get a SCI-focused response first. To add some context, the darker discoloration on the right is basically all above bony prominences: the ischial tuberosities, and whatever the seated area of the tronchanters is (the femoral head), but no differences in temperature or texture (edges aren't firmer, patches aren't mushy).
    Attached Images Attached Images   
    Last edited by faji_tama; 08-14-2017 at 12:15 AM.

  5. #15
    As you know and have guessed, when I said better, I meant that it was looking better, not the same or worse. There is no way that you could totally heal it in a couple of days... SCI or no SCI. Sorry I was not clearer.

    As to the DTI, any changes where the tissue gets darker would be noteworthy. Also, the feel of the tissue below those darkened areas. It should feel like other areas do - firm, not warm and not cool to the touch. It should not feel mushy. I would monitor the areas on a daily or every other day basis, depending on if they have been there for awhile. Not surprising to me that they are over bony prominences. It makes sense.

    I would agree that you should get the area checked out. Better safe than sorry.

    ckf
    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.

  6. #16
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    Quote Originally Posted by SCI-Nurse View Post
    Also, the feel of the tissue below those darkened areas. It should feel like other areas do - firm, not warm and not cool to the touch. It should not feel mushy.f
    On second check, I can't tell if this is mushy, or just fat, but I'm definitely a little more worried now. What's the general approach to handling recovery from DTI? I know bed rest is a huge part, but how does one determine for how long? What sort of doctor do you usually see about the longer term care of it, after it's been diagnosed?

    And this might be a silly question, but how does one handle the bed rest portion if they're on their own? Is it even possible? I know you've mentioned BP in bed, and other threads have mentioned cathing and "showering" in bed as well, but what about cleaning all this stuff? Or feeding yourself?

  7. #17
    First of all, no such thing as a silly question. How do you handle this by yourself? If at all possible, try to get someone to come by daily and help you get set up for the day. Barring that, I would tell you to get organized and keep your trips out of bed to a minimum in time and numbers. Make sure you do plenty of pressure reliefs when out of bed. I think that the key to all of this is being as organized as possible. Having different areas for clean versus dirty products, etc.

    You should see whomever manages your SCI care initially. Some areas of the country have wound care clinics and others don't. If yours does, that would be the next step. Otherwise, a plastic surgeon may be your next best bet.

    I am not sure if I handled ll of your questions. Please feel free to let me know if I missed something or even if you have more questions..

    ckf
    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.

  8. #18
    I also worry that is a pressure sore / DTI, from sleeping on that side at night.

    healing though.... Nice.

    Were you previously sleeping only on your left side all night? Or were you turning and sleeping some on your back /right side? What kind of mattress are you sleeping on? Any overlay in top?

    My father likes to sleep only on his left side, all night. Of course, turning would be better. With aging, his skin isn't tolerating it as well. He developed a ?stage 1 or DTI at his left hip in the same location as yours. We bought a ROHO air mattress overlay, and his skin improved over months. We check his hips regularly...ideally every morning when you wake up to see if they are red.

    your right hip also looks concerning with the spots of hyperpigmentation possibly signs of old injuries.

  9. #19
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    Quote Originally Posted by SCI-Nurse View Post
    First of all, no such thing as a silly question. How do you handle this by yourself? If at all possible, try to get someone to come by daily and help you get set up for the day. Barring that, I would tell you to get organized and keep your trips out of bed to a minimum in time and numbers. Make sure you do plenty of pressure reliefs when out of bed. I think that the key to all of this is being as organized as possible. Having different areas for clean versus dirty products, etc.

    You should see whomever manages your SCI care initially. Some areas of the country have wound care clinics and others don't. If yours does, that would be the next step. Otherwise, a plastic surgeon may be your next best bet.

    I am not sure if I handled ll of your questions. Please feel free to let me know if I missed something or even if you have more questions..
    I just saw my PCP about this, and she said that the darker brown patches do look just like some hyperpigmentation from the constant contact and friction (I do tend to prefer my right side when leaning over, etc etc, so that makes sense why it's more prominent than my left), along with some scar/thinner tissue from old almost-PUs, so just be sure to do constant pressure relief, and possibly add supplements to my diet (protein, zinc, multis). In terms of the supplements, I've seen various folks talk about that on here, but how does one go about determining how much to take when it comes to protein or zinc?

    As for the left side, she doesn't think it's a pressure sore yet, and that the pink is just the normal healing/wound ridge. Still told me to stay off of it until it's better though to prevent it from becoming anything more serious, and prescribed me some silvadene.

    My newer concern now is that I was trying to cath in my chair a few times to avoid the toilet, but it seems like I always hit a snag towards the end that I don't when sitting on the toilet. Stupid me forced it in a few times, and the 3rd time I cathed this way, it seems I nicked something, so there was a little blood clot (or something) at the very end when I pulled my catheter out. Next cath was fine, cath after that had it again, and I had a few blood spots on my pad. Next cath was fine, and this morning had the blood clot again, with a lot more pad spotting after. I don't think it's a false passage (there'd be a LOT of blood if that were the case right?), so probably just a nick from the forcing? Been trying to get in touch with my urologist to ask as well.

    Quote Originally Posted by hlh View Post
    Were you previously sleeping only on your left side all night? Or were you turning and sleeping some on your back /right side? What kind of mattress are you sleeping on? Any overlay in top?

    My father likes to sleep only on his left side, all night. Of course, turning would be better. With aging, his skin isn't tolerating it as well. He developed a ?stage 1 or DTI at his left hip in the same location as yours. We bought a ROHO air mattress overlay, and his skin improved over months. We check his hips regularly...ideally every morning when you wake up to see if they are red.

    your right hip also looks concerning with the spots of hyperpigmentation possibly signs of old injuries.
    So echoing what I just said to ckf, doc said no pressure ulcers or DTI, so hoorah! But still need to stay off of it until it's better. And I actually tend to prefer my right side in general, which is probably why it has larger patches of hyperpigmentation, be it from sleeping, or always leaning over to the right to use sinks, pick up things, etc.

    I wasn't sleeping on the left side ever since I first noticed the pimple though, so I've been sleeping on my right the past week or so now (which I've done in the past as well, so again, right side bias). Usually, without injuries, I'll switch sides every night, and tend to weight shift slightly naturally while sleeping: I usually start sleeping directly on my side (with my face side a little angled more towards the mattress so not directly on my tronchanters), and then will wake up several hours into the night having rolled halfway between my side and my back, and readjust back to my side, if that makes sense. So if directly on my side was 90 degrees, and my back was 0, I start off around 100 degrees, wake up several hours into the night around 45 degrees, and shift back to 100. After I'm healed up, I might start just switching sides completely throughout the night though.

    As for my bed... I have a pretty soft mattress as is, but I also have one of those egg foam layers over that, and then a Tempurpedic foam topper over THAT.
    Last edited by faji_tama; 08-15-2017 at 05:10 PM.

  10. #20
    One thing I noticed is that the foam toppers really start collapsing quickly. Like... in just a few months. I would start flipping / rotating them every month to try to increase their life, and realize that they also will bottom out and don't provide much pressure relief. It may be that you will need to move to an air overlay over time.

    Good luck with the healing though. Good news so far.

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