Renee

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try Cica Care by smith and nephew

Dale WOCN
Manila

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With IV drug use, there is often deep seated infection that will keep emerging unless treated aggressively with IV antibiotics.
Otherwise, treating with moist wound healing and antimicrobial therapies can help.
Renee

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Please bring to your MD visit:
A complete list of all medications, vitamins, occasional Tylenol...
A complete list of medical history
Any blood work taken in the last couple months. especially glucose levels, albumin levels, CBC, Hemoglobin A1C, BUN, INR
Also bring reports from any x-rays, CTscans, MRI's taken, wound cultures or biopsies.
If you can, keep a food diary until you go (all liquids and solids recorded).
be prepared to tell the evaluator detailed information about his/her positioning (in bed and in chair) and how often his/her position is changed, how much help he/she needs to move.
Be ready to explain about how frequently skin is dampened with urine, with feces, with perspiration.
There maybe other information that they will need depending on the locatiopn of the wound but having the above inforamtion will be big help to who ever you see.
Michelle PT, CWS

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Hi Craig,

You didn't mention what part of the body is involved. I am assuming by the fact that you mention progressive deterioration from stage 1 to stage 4 you are referring to a pressure ulcer or decubitus. It is crucial for the wound care center to know for certain whether this was a result of prolonged pressure or some other cause. The patient must receive nursing care in a way that relieves the pressure, or this problem will result in overwhelming infection and death (G-d forbid).

Furthermore, if it was due to pressure, then by definition, your relative is a victim of gross negligence on the part of the hospital and sub acute facility. There is no reason for such a situation to occur other that gross neglect. Therefore, I also suggest that while the patient is receiving treatment for this stage 4 crater, that you contact a lawyer.

You can find more information about bedsores; treatment and prevention in my book Protect Yourself in the Hospital (McGraw-Hill; Nov 2003; $12.95). If you wish to obtain a copy, please visit http://nursetom.com and clink on the appropriate link. You can also go directly to Amazon.com or to your favorite book store.

Thomas A. Sharon, R.N., M.P.H.

Renee

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Hi Jessie,

My first question would be if you have diabetes? The second question would be if you have ever had any studies done on your veins or arteries? Pain can be a complication of chronic swelling of the legs, or lack of blood flow. If you have swelling it needs to be controlled by compression, either by compression stockings, and if you have wounds, by wrapping with a Profore dressing. If the problem is your arterial circulation, you may need bypass surgery to correct the problem...can you give more details?

Marianne Huff, RN, BSN, Wound Specialist

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Please furninsh me a copy, dalegavio@yahoo.com, Im a wound nurse in a Kidney transplant facility.

Dale WOCN
Manila

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This is very complicated. Pain and wounds on the legs can be from different causes and the treatment for each cause is very different. I could not even begin to guess what your wound need, even with a photo. Proper treatment can only be determined by looking at the wound, the skin around the wound, doing vascular tests, and knowing your complete medical history. You really need to seek out a very good and knowledgeable wound care provider. You can go to the American Academy of Wound Management (AAWM) and look for a certified wound specialist (CWS).
Please, don't take advise from someone who has not seen your leg. The wrong advise can lead to much bigger problems.
Michelle PT, CWS

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Hi Ruth, Yes, I know exactly where to purchase a jar of medicinal maggots at. It is the only lab in the USA and Canada that provides sterile maggots for medical purposes. It is Monarch Labs and I am including their info for you. As far as the Leeches there is more info on the BTERFoundation.org web site on the labs who offer medicinal leeches in America!
Pam Mitchell
Patient Advocate
BTER Foundation

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Contact the BTERFoundation.org.
Debby RN CWS

Renee

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Smith&Nephew have one *PROFORE LF that is latex free. Molnlycke Healthcare may have one as well. Hartmann has threepress and fourpress bandaging system (all are latex free).
TJolly,R.N.,WCC

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3M has just launched a 2 layer compression system that is 100% latex free. It's called Coban 2. The patients love it. It is more comfortable, easy to put on and remove. No mess. They can also get their shoes on. It's awesome.

Carly S RN CWS

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Belinda,

Coflex NL made by Andover Healthcare (formally Andover Coated Products) is a latex free version of the Profore latex bandage. Check our site

www.andover-healthcare.com for ordering information.

Michael C. Miller
Technical Resource Manager
Andover Healthcare

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We use a product called tensogrip , on site from BSN medical, which is Elasticated Surgical Tubular Stockinette. It has several uses and comes in a range of sizes from A - M for child size wrist/elbow through to extra large adult trunks. This can be ordered through paramedical suppliers, and comes in about 11 yards so you can cut it to length. Hope this helps.

Sandra Doman
Industrial First Aid services : Co-ordinator
Australia

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Medline has a product similar to Tubigrip, called Medigrip. Maybe that's it? These products are really nice, as they come in different sizes, so you can control the compression strength.
Renee

Renee

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I just met with a wound vac rep. yesterday.
He informed me there is a new wound vac without the use of foam because every time the foam was removed it destroyed the healing tissues and increased the wounds width, length and depth.
Ask about the new wound vac that doesn't use any foam. unsigned

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Believe it or, it is not an unusual problem after giving birth. The reason the wound MAY be larger is because the VAC extracts the fluid, continues to help with the "cleaning" (debridement) and therefore it will be larger before it decreases in size.

I would continue with the VAC, making sure the correct foam (white) is the one being inserted in those deeper areas. Make sure you report fever, foul odor, increase redness or pain to the doctor, so that antibiotics can be ordered.The VAC has a Representative. This person is usuallly a nurse (if not they are still highly trained) to answer your questions as they arise.

This same thing happened to my Goddaughter and she had to be treated with the VAC also, and took about 3-4 months. But all is well now.
Good Luck...
Amy Pastor RN,
Certified Wound Specialist

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Hi, Susan,

There is a device called the Diapulse Wound Treatment System. It is pulsed, not thermal electromagnetic therapy, FDA approved and covered by Medicare for healing of chronic wounds.

Moreover, it seems that these doctors' approach to wound care is what is at least in part preventing the healing; i.e. the packing. Although many doctors still pack open wounds with iodoform or some other anti-bacterial agent, healing depends on blood circulation and packing a wound impedes circulation. The packing is causing pressure and is impeding the blood circulation! The gauze also absorbs the healing factors from the wound bed and those vital elements are being ripped out while the gauze is being removed. Thus you have a very clean non-healing wound. Also, to continue a regimen that is clearly making the situation worse doesn't make any sense.

Also the failure of the hospital laboratory to identify the cultures certainly begs some serious questions about how the cultures were taken and whether any antibiotics were given prior to obtaining the specimen.

My advice is as follows:
- find out if the Diapulse is available in your area for home use - visit http://diapulse.com;
- Bring your daughter-in-law immediately to a wound care center;
- obtain a complete copy of the hospital records ASAP (for legal reasons and this might offer a clue to the new wound care team as to what went wrong).
- I urge you not to delay as your daughter-in-law condition could become life threatening (G-d forbid).

Thomas A. Sharon, R.N., M.P.H.

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There are many soft tissue infections that could be lethal. Please take her to a facility that can diagnose your daughter-in-law properly. Some of these problems can begin at or around a surgical site, or even a little cut could start the destruction of her tissue. This could be quite serious and need immediate attention. I would not to want to even guess what it could be but my recommendation to you is to run to another facility (preferably a Mayo-type) ASAP.
Cindy RN WCC

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Talk with the hospital dietician and her practitioner about adding the supplement, L-Arginine to her diet. Studies have shown increased healing for surgical patients, contraindications are hx of diabetes and/or kidney problems.

Myra Badger, BSN, RN, BC, WCC

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This is a well know risk of any surgery but it can be very complicated to heal. The kind of dressing your doctor suggested is the most commonly suggested treatment for this kind of wound but it has definite draw backs. It does not inhibit infection, it requires frequent dressing changes which are uncomfortable and disturb new tissue growth. Overall, you can heal with this treatment method but you can be expected to heal slower, and with a greater risk of infection. There are great options that can decrease the frequency of treatments, decrease your risk of infection and actively promote healing. I would suggest requesting a referral to a certified wound specialist who can hep select a dressing that will help you met your goals. You should also do an on-line search for an article called "Hanging wet-to-dry out to dry." It is a well written and well researched article that outlines (in 10 pages) why the dressing your using is not first choice.
You are your best advocate, good luck to you! Mchelle, PT, CWS

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Packing a wound could actually retard healing and make the opening even larger. It's amazing to me how many doctors know less than nothing about good wound care. Get yourself immediately to a wound care center.

Thomas A. Sharon, R.N., M.P.H.