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Thread: Stage IV (4) Pressure Sore/Ulcer and KCI Wound Vac

  1. #1
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    Unhappy Stage IV (4) Pressure Sore/Ulcer and KCI Wound Vac

    I've had been battling a stage I pressure sore for over a year. I had been using a high profile Roho in my chair and a low profile in my car the whole time. I dressed it with a simple bandage and neosporin during this time. It never got worse but would not heal either.

    About three months ago I started to run a really high grade fever of 102-103. It only seemed to happen after large meals or at night. This lasted almost a week until I finally decided to go to the doctor. Even though the wound looked very clean, the DO suspected that this was the source of the fever. Blood cultures came back with Candida yeast but for some reason I did not find this out until many months later. Eventual wound cultures from other doctors confirmed this as well.

    Blood tests were mostly normal except that my A1C was off the charts. My diabetes had come back; I had developed diabetes when I was first injured and was receiving high does IV and oral steriods. UTI tests came back negative as well.

    I was prescribed Cipro and Amox and Janumet for diabetes. This seemed to help.

    The DO prescribed wound care as an outpatient. During the first visit, the wound care nurse said the ulcer was not much to worry about and it should heal in a few weeks. She dressed the would with some ointment that removes dead tissue, gauze, that pink pad and Tagederm.

    Over the weekend, the dressing really started to fill up. By Sunday it was so heavy I had to change it. That's when I noticed a tiny hole in the middle of the wound. I began to suspect that there was a lot of damange underneath.

    Within a week, my supposed stage I developed into a stage IV. Eventually, three deep tunnels would reaveal themselves and the little hole would open up to the size of a silver dollar.

    I was definitely freaked out. It looked like someone cut a hole in me with a cookie cutter. After finishing the 10 day dose of Cipro and Amox I felt ok. Unfortunately, the night time fevers came back a week later. I also had really bad cold sweats at night. I went to an internal medicine doctor and a infectious disease doctor. The internal med doctor but me on similar antibiotics but it didn't seem to help. I got a pelvic x-ray which came back negative for osteomyelitis.

    It had been five weeks and I was dealing with a serious ulcer and incredibly bad night time fevers. I would be fine all day and then after 4PM or so, the chills would leave me in bed shaking. Finally one of my doctors admitted me to the hospital for extensive testing.

    I had countless blood tests and cultures taken. Candida yeast came back but not even the infectious disease doctor seemed concerned. The bone scan was cancelled but an MRI finally revealed a early stage of osteomyelitis at the left ischium next to the ulcer.

    Finally the doctors started to accept that the Candida yeast was the cause. I think they held off because they were looking for some really bad bug. The irony behind this is during the 3 nights as the hospital, I didn't get one case of high fevers.

    During the hospital visit I was put on a KCI wound VAC. The wound care nurse strongly recommend I get a compact one.

    The insurance company approved the VAC and a few days later I was going to Wound Care as an oupatient with dressing changes 3 times a week.

    I was prescribed Fluconazole, Levaquin and Metronidazole. I'm on a reduced dose of the Metronidazole because they upset my stomach.

    I've been on the KCI VAC and antibiotics for about 4 weeks now. The wound looks like it's slowly getting better and I still get the occasional fever (not as bad though).

    Today I went to wound care and my infectious disease doctor showed up as well. She seemed a little disappointed with the results after being on the VAC for four weeks. She said if I wanted to get flap surgery or hyperberic she would support that as well. I opted to stay on the VAC for at least another 2 months. My wound care nurse felt the same way since there was slow but consistent progress.

    I'm not sure if there should be significant improvement after 4 weeks but I really think you have to consider all the conditions.

    - During the holidays I got a really bad flu. This can't help the healing process.

    - We have two 8 month year old babies. I didn't get really good sleep during these 4 weeks. (I have ear plugs now)

    - The wound and fevers have caused a lot of tension between my wife and I. We have worked a lot out since then but it was extremely stressful.

    - Work had been crazy.

    - It took about two weeks for us to properly control the sugar with Lantus insulin. It's now between 100 - 120.

    I'm not saying the wound VAC hasn't helped at all because one tunnel has almost filled in and the other two kind of merged into a pie shape. That one is still very deep
    (to the bone) but the nurse seems to think it's getting better. I see a lot of granulation tissue that are starting to form one piece as well.


    I'm eating a high protein diet and taking Juven twice a day. Juven is very expensive so it better be helping.

    I only go into the office 3 short days a week and work in bed the other two. Another of the chance I get I'm laying down.

    I noticed with the wound VAC, you have to be very careful about leaving it off for too long. I remember leaving it off for over an hour and the fevers came back.


    I would also feel feverish if I left dressing is left on for more than 48 hours.


    The nurse will only say that if I can stay in bed for a long period of time then it would help. However, she never says I have to. Most of the wound care nurses there seem to think that pressure relief and the Roho will allow to me sit up.

    Sorry for the long story but if anyone has had a similar situation I would like their feedback. I'm still a little skeptical about this VAC but I'm trying to stay patient.

  2. #2
    Senior Member Broknwing's Avatar
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    Be patient with the wound vac, it does take time, but does work...You shouldn't be shutting it off at all though...Only to take showers or do dressing changes. The max combined ammt of time it should be off in any given 24hr period is 2hrs. Do you have it on constant pressure or alternating?

    You should also try to keep off of it as much as possible. As much as I know that being up helped my wound heal once I did have the wound vac, I didn't have tunneling and I had the means to get off of it after a little while up. You DEF should not be up on it all day, but a couple/few hrs at a time is ok...That's slowing your healing, even with the Vac. .
    'Chelle
    L-1 inc 11/24/03

    "My Give-a-Damn's Busted"......

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    I try to keep the VAC running non-stop. The hose is so long I actually figured out I could leave it on in the shower.

    I have constant pressure on. It runs at 125 mmHg but my nurse is thinking about 150 mmHg due to the tunneling.

    I try to stay off of it as much as possible. On the days that I do go to work, I go home for lunch to lay down or I'll even go to my car and lay down.

  4. #4
    You just have to stay off it - period. The nurses, I think, sometimes feel sympathy and try to just 'suggest' staying off it rather than stating 'stay off it'. Think about it; your wound is right where you sit; your ischial bone is the place your body makes contact. New developing granulation tissue is very fragile; every time you put pressure on it, it can destroy those delicate tissues and you're back to square 1.

    My son was on a Vac, for a similar wound, and ended up having surgery. His had tunneled also; he was on the continuous pressure. Do you know what color sponge they're using? In the tunneled area, the white sponge is supposed to be more effective; its a denser sponge. There is also a combination silver sponge that some docs are using to help fight the infection.
    _____________

  5. #5
    Moderator Obieone's Avatar
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    Bill has been on a Vac in the past with limited success. They are very effective for kick starting the healing process but what Marm says is absolutely true and its probably the hardest part of wound care to accept ........ NO PRESSURE .... ZERO PRESSURE .... THAT MEANS NO SITTING AT ALL ... believe me we know that it is difficult . Bill has finally accepted that when he has a pressure sore of any kind he's off it ...... period .... no questions asked .... but then he had to learn the hard way I'm sorry to say ...... all the best!


    Obieone
    ~ Be the change you wish to see in the world ~ Mahatma Gandi


    " calling all Angels ...... calling all Angels ....walk me through this one .. don't leave me alone .... calling all Angels .... calling all Angels .... we're tryin' and we're hopin' cause we're not sure how ....... this .... goes ..."
    Jane Siberry

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    I 'm using the black sponge. I have heard of the white sponge and the silver sponge but am not sure why they didnt' suggest it. The wound itself looks very healthy and the last wound culture produced nothing.

    I would love to stay in bed until this healed. Before I went back to work, I more or less did this and a sore healed in a month. It was a stage 2 at the ischium.

    I had another stage 2 at the sacrum after I went back to work and I got that to heal in just over 2 months. Although, it's easy to stay off of it once you learn how to sit and sleep.

    This is a stage IV that's in a very bad spot. I've already reduced my sitting time tremendously but am considering disability or working from home.

    What did Bill do about work if I may ask? My wife is a stay at home mom and I'm the only one that goes to work.

  7. #7
    Senior Member Quadcessible's Avatar
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    Quote Originally Posted by walkanotherday
    I 'm using the black sponge. I have heard of the white sponge and the silver sponge but am not sure why they didnt' suggest it. The wound itself looks very healthy and the last wound culture produced nothing.

    I would love to stay in bed until this healed. Before I went back to work, I more or less did this and a sore healed in a month. It was a stage 2 at the ischium.

    I had another stage 2 at the sacrum after I went back to work and I got that to heal in just over 2 months. Although, it's easy to stay off of it once you learn how to sit and sleep.

    This is a stage IV that's in a very bad spot. I've already reduced my sitting time tremendously but am considering disability or working from home.

    What did Bill do about work if I may ask? My wife is a stay at home mom and I'm the only one that goes to work.
    Walkanotherday,
    The Wound V.A.C. is ideal for healing the tunneling. The type foam used depends on the wound. White “Sliver” is used for infected wounds. I just got off the V.A.C. 3 weeks ago after 18 weeks use. I had a tough healing wound de-breed. I live alone and have a wound care nurse 3x weekly now using Aqua-cell Ag with covered dressing. Pretty good results so far, measured at 1.2 cm wide x 2.5 long and about 0.5 deep with good granulation. I have no choice and have to sit to cook and eat. I try to sit no more than 1-1.5 hours at any time 3 xs a day or 3-4 hours total in a day “4” Roho Cushion” weight shift frequently, careful not to shear. Wound V.A.C. info can be found here http://www.kci1.com/82.asp . The more pressure you keep off it the quicker it will heal. My nurse is very well trained in healing SCI pressure sores. She consults with other wound care specialists and even brings some by to get opinions; I think they have pictures all over their web sites checking my butt. One other thing is my nurse isn’t afraid to adjust dressing techniques to keep the wound from stagnating growth. Little adjustments seem to help a chronic wound especially a thorough cleaning once a week to remove any calloused tissue. I went 20 years without a problem and one poor transfer and a cut butt from hitting a clothing guard has put me down for over a year. I am lucky and can work full time from home using a laptop. See what you can work out with your employer.
    Good Luck

  8. #8
    Moderator Obieone's Avatar
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    Well the truth is walkanotherday Bill hasn't worked in about 7 years ... he collects a disability pension and I work part-time in a bank. He did work for a brief period of time after he was injured .. at home on the computer as a dispatcher for the trucking company he drove for once upon a time .... but that had to end because he had so many health issues !

    Although staying off the butt is an essential element for proper wound healing I understand that for some its a question of survival if there is no other source of income and of course if you live alone you have to eat ..... what's a person to do ... lets face it living with sci is the pits no getting around it !

    Obieone
    ~ Be the change you wish to see in the world ~ Mahatma Gandi


    " calling all Angels ...... calling all Angels ....walk me through this one .. don't leave me alone .... calling all Angels .... calling all Angels .... we're tryin' and we're hopin' cause we're not sure how ....... this .... goes ..."
    Jane Siberry

  9. #9
    Quote Originally Posted by Obieone
    Bill has been on a Vac in the past with limited success. They are very effective for kick starting the healing process but what Marm says is absolutely true and its probably the hardest part of wound care to accept ........ NO PRESSURE .... ZERO PRESSURE .... THAT MEANS NO SITTING AT ALL ... believe me we know that it is difficult . Bill has finally accepted that when he has a pressure sore of any kind he's off it ...... period .... no questions asked .... but then he had to learn the hard way I'm sorry to say ...... all the best!


    Obieone
    Obie,how much has Bill improved since he got low pressure bed? What is size of his wound now compared to it's size prior to obtaining bed? Get him a high profile Quadtro,Roho and he will be okay sitting up several hours per day.
    How long before his wound heals?

  10. #10
    Hi,

    Sorry about your situation. I know the vac can hasten healing but still can feel like a slow process. To improve the VAC process, you should fully comply wth all instructions including staying off it totally. I would pose the question to the owund care specialist- how can we aggressively heal my sore? what should I do to get the optimal healing that I havent been doing?

    RE your working, I would speak with your employer but only and your family can decide what is workable for you.

    Re the flap surgery, sometimes in terms of healing time, this can give you the best bang for your buck so to speak. It does require a large outlay of time, in hospital, on your back for several weeks approx 3 then slow wedging, then progressive sitting. i would discuss all options with your provider at this point to come up with the best solution relative to your other lifestyle factors. Weigh your options and make the best decision.

    Keep us posted.

    AAD

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