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Thread: Urgent question for the SCI Nurse: MRSA, pressure wounds and hyperbaric treatment

  1. #1
    Senior Member vgrafen's Avatar
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    Urgent question for the SCI Nurse: MRSA, pressure wounds and hyperbaric treatment

    I have been enduring 16 months now of this MRSA infection and stage 4 pressure sore on my right ischium. In the past three months, the infection has been localized in the wound and I have not been anywhere near as sick as I was all of '07. The wound, however, has only marginally progressed, showing some signs of granulation and shrinkage but nothing to really get excited about. I'm spending about all my day in bed or standing, I've been on and off the wound vac since January, lately off when the bandage begins to stink.

    I seem to be getting re-infected in the wound now almost monthly. The local docs keep putting me on this or that oral antibiotic combo, but to no long-term effect. I'm getting progressively weaker due to the constant stream of antibiotics, and am now looking again for any help beyond yet another round of these drugs. Once again, I'm doing 3 tbs of turmeric daily, and I'm headed over to the natural food store for some Allicin, the garlic extract.

    I've done some research on hyperbaric oxygen treatment for wounds like mine and am going to see a doctor today to begin the process. I'm told I'll need 5 day a week treatment for several weeks.

    Man, I'm tired of this cycle, it's wearing me out and I'm certain I can't keep taking one after the next antibiotic, yet I'm not progressing.

    SCI Nurse, can you give me any insight into hyperbaric treatment for wounds? Am I headed in a sound direction? Any thoughts on this 16 month antibiotic cycle? Any alternatives? How long can I reasonably go taking orals antibiotics, or should I consider Vancomycin again?

    I ain't doin' too well, and any help at this point would be greatly appreciated.

    v
    vgrafen

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  2. #2
    i have done two different rounds of HBO treatment. a total of 40 treatments per round. it can be very closterphobic, and the stretcher is hard so make sure they offload some pressure, but there is not enough room to completly roll on your side, at least not for me. if you have problems with the treatments they can medicate you to make it more comfortable. i didnt notice significant improvement in my woundsd but they were treating the osteomylitis too. also i wlould suggest vancomycin again unless you have VRE. you can do the vanc during your hbo treatmets. hope this helps some

  3. #3
    Senior Member lynnifer's Avatar
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    I'm sorry you're still having trouble vgrafen! I so know what it's like to 'feel sicker' on all those antibiotics.

    A word to the wise though ... I was on Cipro for the same amount of time and it's resistant to me now for that infection. I grew resistant to Ceptazidine by IV as well and had an allergy to Meropenum.

    I hope this all changes for you soon. Take those HBOT treatments - I would if I were you. This has been going on far too long.
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  4. #4
    How come no one is suggesting surgery for you? I have a pretty bad one on my left ischiumthat I'm having a flap surgery done on in July although I would prefer for it to heal naturally, I'm just not willing to wait that long.
    C-5/6, 7-9-2000
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  5. #5
    Senior Member vgrafen's Avatar
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    Problem with surgery is that, if we do a flap and the infection returns, everything is undermined, even worse. I have to be infection-free, I assume, before I can consider surgery, which, to my way of thinking, is only the very last resort.
    vgrafen

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  6. #6
    First of all, have you had a bone biopsy (not just a swab of the wound) to determine the bacteria causing your osteomyelitis? Are the antibiotics you are taking based on this, and prescribed by an infectious disease specialist? This is critical. There is no way to determine if the right antibiotic is being used without this. Have you also had a pelvic MRI to determine the extent of the osteomyelitis?

    Has the dead bone been debrided and the wound itself debrided? Have you been on silver or other antibacteria wound treatments in addition to the antibiotics?

    You are right that the flap should not be done until the osteomyelitis appears to be gone (CRP is normal, sed rate is normal, MRI looks normal, bone scan is negative, etc.). Unfortunately it can still sometimes come back, and if it does, it is likely that the flap will breakdown or an abscess will develop.

    HBOT is most effective for gram negative bacteria, which MRSA is not. It may be worth a try, but it is very expensive, so not all insurances will cover it, and there is certainly no guarantee it will help with the infection. I have seen it help, and I have seen it be a big waste of money. It can, as above, be very claustraphobia inducing as well.

    (KLD)

  7. #7
    Senior Member vgrafen's Avatar
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    No, I have not had a bone biopsy; we did CT and MRI in December and the docs determined then I did not have osteo.

    No, I am not currently seeing the infectious disease specialist.

    I have been using silver sponge in the wound vac. Yesterday I began an alternative treatment -in lieu of another round of antibiotics- including coloidal silver, oil of oregano, turmeric, golden seal and raw garlic. I am taking acidophilus, lots of yogurt, Vit C and E, protein supplement, plenty of lemon juice and water, and fruits and veges.

    I will be seeing the wound care nurse in a few minutes, when I will suggest another look at osteomyelitis, then I head over to Chico Hyperbaric and begin HBO treatment; no, insurance won't cover it so it's out of my pocket but I have got to get some healing and HBOT.

    My body is so worn down by the endless litany of antibiotics that I am fearful of yet another round. When I called in my symptoms on Monday to my doc, the nurse went and ordered THE SAME ANTIBIOTICS THAT I HAD JUST FINISHED! Wow, that's punting the ball, isn't it? Essentially saying, "Uh, v, we really don't know what we're doing, and we really don't have any help for you." Or am I mistaken?

    At any rate, I am not going to take another round of the same 'ol, and am going to try the alternative method. I'm not worried about claustrophobia, and I'll just go back out in the street and sell my body to beautiful women to round up the necessary cash, my usual money-making method.

    In sum: your assumption, then, is that I do have osteomyelitis and/or I should be more vigorously tested for it? Any other light you can shed? What about Vanco or Vanco-like 'last line of defense' drugs? How are they in oral doses vs. IV?

    Yeah, you no doubt can detect that I'm reaching...
    vgrafen

    My book, 'Scouring the globe for a cure: a disabled man's experiences with stem cell treatment' is available at Booklocker at the following address:

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  8. #8
    vgrafen, im really sorry to hear about what you have been going through i really feel for you. one thing i will say is hyperbaric oxygen therapy will work for if you are patient and are disciplined. it is a slow process and going by how you described yourself you will need quite a few treatments. HBO works very effectively against MRSA. our hospitals here in ireland are full of it and it is only after an incredible amount of people died have doctors admitted HBOT works. MRSA is anerobic which means it hates oxygen...and what is HBOT about????..oxygen. Best of luck in what ever you choose

  9. #9
    vgrafen,

    I am nine months with a stage four, ischial wound . I have been off and on wound vac with some success. I went almost 5 months with an ugly wound and finally found out my pre-albumin and albumin levels were seriously low. I am a surgeon ( I also did wound care) who really was enjoying losing weight and I'd never thought about protein malnutrition as a possibility. I reflected on my "diet" and the fact that an open wound loses a lot of protein -- and all of a sudden it was obvious. I started on Juven -- the best protein supplement out there because it has high concentrations of the most important amino acids -- and the wound shrank by two thirds within two months. I'm off the wound vac now because I have hit a wall. I am back on "wet to dry" guaze dressing changes and it has begun to heal again. I am also considering HBOT, but I'm not through researching it.
    Some random thoughts:
    1. What is the diagnostic basis for osteo if you have any negative MRI and CAT scan?
    2. How is the diagnosis of wound "infection" being made? Do you have erythema, swelling, and a tissue biopsy culture? Or is somebody just swabbing the wound and getting a culture. If it's the former, then a "wound infection" is legitimate. If it's the latter, that just means the wound is "colonized". I agree that taking the same antibiotic over and over is not a good idea. That is just encouraging drug resistance.
    3. Is the wound being regularly d├ębrided? At least once a week, the granulation base should be "scraped" of the superficial layer to encourage further healing. If it bleeds some, that is a good sign. Holding gentle pressure with a saline moist guaze will stop that.
    4. I definitely agree with KLD that I would Not start on an antibiotic for osteomyelitis without a bone biopsy proven infection. Also, I agree with some sort of silver application with the wound dressing.
    5. I don't think you need an infectious disease specialist unless you are growing some weird bacteria. A reputable wound care specialist should know how to handle things. Sometimes "too many cooks......."
    6. I am also delaying flap surgery. I do not want to lay on my stomach for six weeks.

    Good luck! If the hyperbaric oxygen works, I hope you will share it with us.

    David

  10. #10
    David, of course I have not seen your wound, but do you have experience using either Regranex or Oasis for wounds that become static? We have use both (although not together) for those wounds that progress and then seem to just stop. The Regranex, being a tissue growth hormone, needs to be applied daily and the wound still kept moist. We don't use it under a VAC though as it just sucks the gel up into the sponge.

    With Oasis, we have used it both under a VAC (with Adaptic in between left in place for a full week, changing only the sponge) and alone covered with a moist dressing. There is some excellent evidence for its use in matrix-deficient wounds, and it seems to help to "jump start" healing in many. We may only need to use it for 2-3 weeks (which is 2-3 applications usually).

    Both are expensive, but can be well worth a try if nothing else is working.

    I am glad you mentioned the nutritional issues. We monitor pre-albumin, albumin, transferrin, and H&H weekly on our serious pressure ulcer patients, and get very aggressive with nutrition. We often use an NG tube or peg to get as much in as possible, even for patients who can and do eat. We never consider surgical closure until we get the person buffed up nutritionally, so often surgery must be delayed even after debridement and IV therapy antibiotics is completed in order to meet the criteria we have set for this. This is addressed very well in the clinical practice guideline on pressure ulcer management and SCI from the Consortium for Spinal Cord Medicine.

    (KLD)

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