Magic wand needed for sores

Discussion in 'ARCHIVE FORUM: Support discussions' started by Nutty Nan, Jun 2, 2008.

  1. Nutty Nan

    Nutty Nan Registered User

    Nov 2, 2003
    787
    Buckinghamshire
    Incontinence / immobility / sacral sores ....... a vicious circle and very little constructive advice about a remedy .....

    District nurses have tried dressings - they are not only inefficient, but actually 'catch' waste and leave a sticky residue which attaches itself to the pad.

    We have been given Cavilon, which is supposed to be the bees' knees of creams - so far no noticeable improvement.

    I am at my wits' end, wondering how much worse the sores will get (currently 2x3cm on each cheek). Today, the nurses hoisted my husband into bed (instead of the wheelchair), on his side, to relieve the pressure, but he is most uncomfortable this way and completely unable to eat or drink anything. Far from ideal, as he has only just recovered from being dehydrated :(

    I asked about a rubber ring (such a treasured item on maternity wards - why not!), but apparently they are now frowned upon.

    We can't be on our own in this predicament. Does anyone have any suggestions??
     
  2. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Oh dear, Nan, that sounds awful. John has had a sore on his heel for five months now, and it's still not healed. But at least we haven't the possible infection from pads to worry about.

    Are the sores wet or dry? Because that makes a difference to the treatment. The latest dressing John has is Biatain, but I think that's for exuding sores, though there may be a version for dry.

    Do you use an air cushion on the wheelchair? They all have them in John's unit, and John even has one on his tilt & recline chair, for extra protection. None of the residents seem to have sore bottoms, though almost all are incontinent.

    I'll ask tomorrow if they have any suggestions at the home.
     
  3. gigi

    gigi Registered User

    Nov 16, 2007
    7,788
    East Midlands
    Hello Nan,

    What a predicament..I agree with Hazel..an air cushion in the wheelchair..

    Am surprised the DN's haven't suggested this..a similar mattress on the bed would be helpful.

    Meanwhile..all I can think of is to use a rolled up towel or soft cushion to ease the pressure..place it under the top of the thigh to try to relieve the pressure..and change sides with it every hour..or..if possible..stand your husband every hour or two..

    It's so difficult once these sores develop..creams may assist..but the only way to heal is to relieve the pressure.
    I think that's why rubber rings were banned..because the pressure is put somewhere else..
    But I don't see the harm in using something like that to ease the pressure on the existing sores as long as you're aware hubby will still have to be moved periodically.

    So sorry you have this to deal with...it's added hard work on top of everything else..

    Love gigi xx
     
  4. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
    Dear Carmen, we are fortunate that Lionel has not had a reacurrence of this problem since they changed his bed. He now has adjustable bed, with ripple air mattress.

    I realise you are still caring at home. Would/could the District Nurse help in any way. (They were the ones that came into the home every day to treat Lionel last year)

    Thinking of you, love n'hugs
     
  5. DeborahBlythe

    DeborahBlythe Registered User

    Dec 1, 2006
    9,222
    This is what I was going to suggest too, as my mum has one. The ripple air mattress has waves of air rippling through it and this alternates the pressure locations. She was first given one on a hospital ward after I heard of their existence and badgered for one. Then I never let it go! (I mean the issue, not the precise mattress!) The DN service got her one for the residential 'home' she was in and when she moved to a NH, I made sure they supplied one there too.
    In her wheelchair she has a 'gel' cushion, which relieves pressure.
    Her btm is not entirely painfree but the skin has never broken and she is managed by two hourly turning when in bed.

    Hope this is helpful. I'd definitely try and get the DN's to supply the adjustable bed and mattress if you can.
    Regards, Deborah
     
  6. Sandy

    Sandy Registered User

    Mar 23, 2005
    6,847
    Hi Nan,

    Sorry I have no first-hand experience of this myself. Do you think that it is perhaps time to ask for some more specialist medical input? I'm sure I've seen something about "Tissue Viability Nurse Consultants" who are experts in wound care.

    I could be wrong but I think dehydration (and poor nutrition) can be risk factors for pressure sores, so you are quite right to be concerned about maintaining a good fluid intake.

    I hope you can get the support and advice you need, both from TP and your local medical team, to make it through this current stage .

    Take care,

    Sandy
     
  7. citybythesea

    citybythesea Registered User

    Mar 23, 2008
    632
    coast of texas
    Nan

    I can relate. Mom has one on each cheek also. There is no way to take pressure off that area without turning them on their side. Some are not even started as pressure sores but as shears. These are caused by movement across the skin such as "scooting"...sliding down in a chair or bed, whatever the point of pressure is on. Anyways the outcome seems to be the same..a bed sore, tho shears start on the top and if caught early can be heeled...in someone who still has proper blood flow and nutrition. Shears usually look like a bruise first wheras bed sores start as a red spot down deep.

    kBKack to your question. I almost had one totally cleared up on mom until this last turn. It was a long process and mind you if you turned her on her side she would get soft spots on that side. I spend most of my days arranging pillows underneath her legs and thighs to lift her up a little and use her bed to adjust her sitting position as we have a hospital bed. I have four creams I use...but not together.

    1...neosporin...this is an over the counter triple antibiotic (bacitracin,neomycin andpolymyxin)
    2...skintegrity hydrogel...a greaseless hydrogel used in the maintenance of a moist wound (among other ingredients it has aloa vera
    3....derma-gran ointment..used in the last stages of healing to help it get just back to healed
    4....silver sufadiazine....name says it, it's by prescription and is used on a shear in it's very early stages and helps keep them from turning into bed sores (has worked on 3 very mild shears that had not gone to the bruise stage)

    When the sores are mild I cover them with what is called a tegaderm. It is a transparent dressing that can be seen through and is used as a second skin to protect the skin. I put those on the "red spots" I have found on her ankles and heels..have not had a bed sore there yet. (Knock on wood.)

    For the bed sores you talk of I am currently using a dressing called 'duoderm'..it is not see thru and is the "color" of skin. I thoroughly clean the ulcers then apply a mixture of 1 & 2. Then I cover with the duoderm. This dressing is made to stay on for up to 7 days. Experience says maybe 3. I put a tegaderm over the top of that because the tegaderm adhere much better. Changing the dressing every 3 days seemed to work really well and we almost were cleared up to nothing until mom had this last downhill spiral. Mom had one bed sore before her first hospitalization with her bladder. Before she had her catheter I also used A&D ointment around the area to keep it dry. (This is used to keep babies from getting diaper rash.) I would use it all the way up to the edge of the dressing. I was also changing diapers ever 2 hours.

    Nan I apologize for this being so long. I just wanted to let you know how I am handling them. In my opinion they are little ******s. I also know that when mom first started getting them I upped her intake of protein, which also seemed to help.

    Gigi mentioned a mattress, they do have an item that goes on top of your mattress that pressure can be regulated in it sort of looks like a huge bubble wrap. There are 2 sets of air chambers that go through these bubbles. The compressor alternates the 2 chambers so that at some points an area has more air in it than other times. I do believe this has helped mom as we were unable to rotate her.

    Once again I apologize for this being so long. Feel free to msg. me if you need. Have gotten good at recognizing and healing before they get dreadful. Tho' I do feel that I may not win with her current phase she is in.

    HUGS

    Nancy
     
  8. Nutty Nan

    Nutty Nan Registered User

    Nov 2, 2003
    787
    Buckinghamshire
    Thanks!!!

    Thank you all so much - I must apologise as I omitted to say we have had a gel cushion for over a month now, and a 'repose' mattress (a bit like a thin inflatable mattress on top of the normal mattress). The DN suggested they should order a new mattress today, rather like the ripple mattress you describe, so I feel we are well looked in that respect. The DNs have been tending to the pressure sores on his heel since the beginning of February, but there is almost no healing taking place.

    As he has now lost all mobility, we rely on hoisting, which, sadly, limits any chances of pressure being taken off his bottom - no chance of any fresh air or sunshine getting to such badly affected areas ....;) Unfortunately, the sores are not only wet, but bleeding, which is why I am so desperate for the above mentioned magic wand!

    He is amazingly tolerant (except when being turned on the bed, which scares him rigid), but he actually made my day today when he suddenly swore like a trooper (not at all typical!): I saw it as a wonderful sign of his fighting spirit emerging, and I just feel so helpless now that just about everything is breaking down. -
     
  9. citybythesea

    citybythesea Registered User

    Mar 23, 2008
    632
    coast of texas
    Nan, He sounds almost exactly like mom. No mobility and scared when she is on her side. I think they feel they may fall on the floor. I know she is much more comfortable when I am on the side she can see.

    HUGS


    Nancy
     
  10. Nutty Nan

    Nutty Nan Registered User

    Nov 2, 2003
    787
    Buckinghamshire
    Nancy, our posts seem to have crossed. - Certainly no need for apologies. Where information is concerned, the more the better!
    You've given me fresh hope - fingers crossed we will win this round; I suspect the next obstacle may not be far away...
    Once again: many thanks!
     
  11. gigi

    gigi Registered User

    Nov 16, 2007
    7,788
    East Midlands
    Dear Nan,

    I can understand how you must feel...

    The DN's must be aware and am sure they'll work with you to find a solution..it must be so tough dealing with the mental breakdown..alongside the physical breakdown too as a result of this..

    In truth this is what I'm fearing as I see my own husband become more immobile, more prone to falls,more unwilling to walk or attempt any physical activity..I am becoming resigned to it now..it seems to be the way forward..

    And threads like yours help me to prepare for that future..so in a strange way it's quite positive..thankyou!

    Love gigi xx
     
  12. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Nan, John's the same too. Has to be moved from bed to chair by hoist.

    Nancy's duoderm sounds exactly the same as Biatain -- it too can be left for up to seven days, though it only lasts three with John. It's worth asking about.

    Sandy's right too. They had a tissue integrity consultant to look at John's heel, but they're thin on the ground. Definitely worth asking, though.

    Love,
     
  13. Nutty Nan

    Nutty Nan Registered User

    Nov 2, 2003
    787
    Buckinghamshire
    Dear Gigi,
    The only way we can cope with this hopeless disease is by concentrating on the present, celebrating whatever is still possible, achievable, attainable ...... the rarer the smiles, the more precious they become!
     
  14. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Nan, I asked the charge nurse at John's NH what they did in cases like your mum's.

    He said they most important thing was to keep the weight off the sores, so he agreed with your DN that your mum should stay in bed for a few days to give the sores a chance to heal.

    They use Granuflex dressings for that kind of sore.

    Love,
     
  15. May

    May Registered User

    Oct 15, 2005
    627
    Yorkshire
    #15 May, Jun 4, 2008
    Last edited: Jun 4, 2008
    Nan

    So sorry to hear you have the problem also of bed sores, they're the very devil to treat.:( My Mum is in a nursing home, and has had a small (ish) sore now for months. Not the homes fault, it's down to immobility. They have and are doing everything they can. She has an airflow mattress and bed which is electrically operated so her position can be changed. They turn her from side to side every two hours using pillows to raise her on one side. She has an airflow cushion if she needs to be in a chair (ie wheelchair for showers). They keep a dressing on the sore, it is now dry and about an half a centimetre across, which is a considerable improvement but it has taken months to get it to this stage.I will ask if they use any specific dressings when I go next. I wonder would a 'memory foam' mattress cover be any better for taking the pressure off, I think they mould to the body shape. Do hope that you get as much help for you and your husband as possible on this. Take care.
     
  16. Nutty Nan

    Nutty Nan Registered User

    Nov 2, 2003
    787
    Buckinghamshire
    Thank you so much for all your replies. It is interesting to swap notes!
    We've had quite a week: dozens of people in and out, lots of help and advice, new airflow mattress, Biatain and a host of other dressings (pure honey!) are being used, we are fortunate to have so much support.
    But hubby managed to generate another crisis on Friday (it's always Friday ..... :eek:) with blood in his urine (UTI?!) and massive projectile vomiting. In over 30 years of knowing him, I have never known him to vomit! Thankfully, the District Nurses reacted quickly and managed to stop the vomiting with an injection, but I still slept on a mattress by his bed, just in case things got worse overnight.
    He is now keeping antibiotics down, but hardly any food or drink, as the old swallowing problems are back. - We had been doing so well ..... it is one step forward and two back at the moment.

    At least the sun has come out today :)
     
  17. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Dear Nan

    So sorry you have this new problem. It sounds as if you have a good team behind you, though, and hopefully you'll get through it.

    I give John Manuka honey (from the health food store -- has to be at least factor 10) orally as well. He has a teasspoonful after each meal, and I'm sure it's helping. It was gigi's suggestion -- google Manuka honey for more info.

    All the best to you both.

    Love,
     
  18. hendy

    hendy Registered User

    Feb 20, 2008
    506
    West Yorkshire
    Dear Nan, Hazel and all
    Just catching up with this thread,as sadly we may have a common interest in bedsores. Dad is on an airflow hi tec bed. He suddenly lost his mobbility and when in hospital he had sore spots in a number of places(hip and bottom)they're doing evrything they can to prevent them breaking down. Can anyone tell me if bed sores happen quite quickly, or do they take a while to develop. Dad is very emaciated and is recovering from pneumonia, does this make them worse? Sorry to jump onto your thread Nan.
    I hope your husband is feeling better soon, both of you have got such alot to deal with at the moment, take care
    hendy
     
  19. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Hi Hendy

    I believe pressure sores can develop quite quickly, particularly if the person in emaciated, as so many dementia patients are. I also believe that they come back quickly if the patient is left for too long in one position.

    I've been talking to John's CN about it. There's one tiny little lady of 96 who is regularly missing from the lounge for a few days. Apparantly she has recurring sacral sores, and when they look like appearing, they leave her in bed for a few days and turn her regularly.

    John's heel wasn't a pressure sore, he's still well-covered. It was an abrasion blister which turned into a gaping crater. He has one on each heel, one healed quite quickly, but the other became infected, and that's what's causing all the trouble.
     
  20. citybythesea

    citybythesea Registered User

    Mar 23, 2008
    632
    coast of texas
    Skye is most right about pressure sores..they can appear as quickly as morning to night. When that little pink spot wouuld appear I was quick with the tegaderm (clear bandage acts as second skin) they never turned to full bed sores. On a bright note...even when mom was going..fast.. I kept the douderm with neosporinand skintegrity mixture on her bottom and am happy to say that she was able to pass with only a barely level 1 blister. Even when times were tough they managed to show some healing with the regimen I used.


    HUGS

    Nancy
     

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