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Thread: PRESSURE SORE: left buttock

  1. #1
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    PRESSURE SORE: left buttock

    - 4.5 years post injury (T9/10 para) and this is first pressure sore.

    - sore located on left buttock
    -- work 9 to 12 hours a day (16 hours in chair a day)
    --- Read Old Pressure sore thread
    --- Will try to follow suggestions--putting instructions on computer desktop background....
    -- use Invacare MVP (going to Ti Lite folder in May)
    -- use Stimulite Classic cushion
    -- use alternating air mattress on top or regular mattress

    - Questions:
    -- What specific things do I need to do immediately?
    -- Hydrocolloid (what is it), medicines etc.
    -- I will make an appointment with my VA rep on Monday
    --- I'm currently taking:
    ---- 20 mg of Baclofen QID
    ---- 20 mg of Oxybutynin BID
    ---- 5 mg Valium QID or as needed (mostly once or sometimes twice a day)
    ---- 500 mg Calcium w/vitamin D once a day
    ---- Vita-Lea® without Iron
    ---- Energizing Soy Protein
    ---- high fiber cereals with SILK
    -- Is this a "ischial" ulcer?
    -- Where can I find photographs of pressure sore stages--did not see them at NPUAP?
    -- Can I continue to work as long as I stay off my left side and bust more?
    -- Today I'm staying in bed and laying on right side--will alternate all day and night.

    I know part of problem is I don't shift or position change enough. I sort of go into a trance at my computer to tune out the extreme burning I have from the waist down--24/7-no combo of meds has worked. But I must work as long as I can to make sure my wife and daughter are as well off as possible when the end comes--you may have different views about this, but in a "democratic" "capitalist" state, for good or bad, this may be the only hope of keeping a roof over their heads...

    [This message was edited by Obieone on 04-09-05 at 11:53 PM.]

    [This message was edited by SCI-Nurse on 04-12-05 at 05:29 PM.]

  2. #2
    Senior Member lynnifer's Avatar
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    I work full time shift work of ten hour shifts which translates to a long time spent in my chair as well. I have long-term pressure sores on my feet. I've HAD a sore on my arse many years ago that required surgery.

    I'm sorry, but you need to INVEST SOME MONTHS off your backside so you can work again later - one day isn't going to do ziltch. Many factors can contribute to a pressure sore .. diet (which is certainly affected by us working full time!), circulation, seating, time spent in chair, etc.

    What stage are you? Stage I is only redness over the boney prominence. Stage III-IV is all the way through the skin layers with Stage IV possible exposure of bone and necrotic (dead) tissue.

    A hydrocolloid dressing tends to draw out the exudate (leakage) from the Stage III or IV wound. If your wound has a lot of leakage, perfect dressing (I use Biatain by Coloplast - $80 Canadian for a box of 10 4x4's).

    Have you sought a seating assessment? I haven't had a sore on my arse since age 15 (I'm 32 now). I use a Jay Active.

    I recently found out I'm iron deficient and started taking iron supplements - I've seen an improvement already.

    Is there any way you can take a sick leave from work?

  3. #3
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    lynnifer - thanks for reply. I feel it's either a stage II or III, that's why I wanted some pictures. It's red and the skin seems scaly feeling. Doesn't seem to be any thing coming out of it right now--I still can't get a good look at it no matter what mirror I use.

    I will probably take a few days sick leave next week- I not due back to work until Tuesday so thtat will give me a couple more days--although I need to be putting a belt on the riding mower...

  4. #4
    You must stay off it completely. This may mean taking a leave of absence from work, or family leave if you can get it. If you sit at all for any reason, it will only get worse. This means not getting up for meals, bowel care, etc. etc. etc. You must stay off it in bed too. No sitting up with an adjustable bed.

    A stage I pressure ulcer does not have broken skin on the outside. It is red, does not blanche, and has no drainage. A stage II looks something like a scrape...just the top layer is missing, and there may be moist drainage, or a scab. A stage III goes into the fat or up to the muscle but not through it. A stage IV goes all the way through the muscle and may expose bone or joint.

    Pressure ulcers beyond a stage I are NOT a do-it-yourself problem. You need to see a wound care specialist. Most home care agencies have access to a wound care nurse who can get you started on the right treatment. You also may need a special bed.

    Eat lots of protein, drink lots of fluids, and take a multivitamin with extra A, C and E.

    Most important though is STAY OFF IT COMPLETELY.

    (KLD)

  5. #5
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    If you don't give this immediate, 100 percent priority until it is healed your total down time will be exponential. The quicker you accept the fact that you are completely off your butt until it heals the quicker you will be back up.

    Sorry dude.

    Your previous care was also insufficient so after it is completely healed you need to modify your sitting habits that allowed it to happen in the first place

  6. #6
    I also have a hard time finding good photos of pressure ulcers on the Net, but I have tons of them at work I can post, so will do so tomorrow.

    Here are some diagrams that are pretty easy to understand though:

    Stage I


    Stage II


    Stage III


    Stage IV


    (KLD)

  7. #7
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    SCI-Nurse and Cris- thanks a bunch. I appears to be at Stage II. I bought a donut yesterday, but I don't know if that's any good because it may just stretch the skin-I am able to get the sore in the middle of the hole though.

    "Rough" estimation of time to heal?

    I have to go get taxes done today and then stop by work and take some leave and then I will be off of it.

    Eating lots of protein, taking all the necessary vitamins and laying on left, right, and stomach to stay off sore...

    Thanks again...

  8. #8
    Moderator Obieone's Avatar
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    Listen to SCI nurse and the others Em ... my hubby was hurt cutting wood same as you and is 56 years old, T5... we just got over this whole pressure sore routine culminating in two flaps having to be done ... roughly 2 years!! Although there were other things going on in Bill's case don't ever underestimate the seriousness of these sores! Catch it before it gits ya' ..... now throw that doughnut away and get off your butt now ...

    Obieone

  9. #9
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    Obieone - whewwwwwwww.... I went to work and took leave for rest of week....

    thanks

  10. #10
    NEVER use a donut to sit on! It will make the pressure ulcer worse. There is no way to safely sit on any kind of cushion and have any hope that an ischial pressure ulcer will heal.

    If you stay off it completely and get expert wound care and consultation, there is a chance that a stage II will heal enough to sit in 2-4 weeks. If you continue to sit, and get a stage III or IV, you are looking at major surgery, 2-6 weeks in the hospital (with no sitting for at least 6 weeks), and another 4-6 weeks of limited sitting to get to 4 hours twice daily. Even then your skin will NEVER be normal again (after a flap).

    Take the time now, if you care about yourself and your family, to catch this early and deal with it now!

    (KLD)

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