Theory of getting older

[gophert]

They have said I've been doing a very good job.

It sounds like you are doing an excellent job. You are a good person.

 

[Inquisitive]

Wound-care is a science and I had to learn that science much better than the nurse. I've been told that the wounds on her legs are uncurable. They are essentially a large area red pigment under the skin and will re-occur if bumped really hard. I believe they are curable, but I ran out of supplies.

This may be of interest.

https://www.silverlon.com/silverlon-wound-contact-dressing

 

[cowboybob]

I'm very impressed with your dedication, KISS.

You are an exemplary son...

 

[KeepItSimpleStupid]

I forgot what I was going to add to my post, but mom got delivered to a respite care facility that specializes in wound treatment (accidently?). Hey, it was close to the house and they had a bed. They said it wasn't stage one anymore because the blood refills quickly. They said I did a good job and asked what I used.

They are going to compound a mixture of zinc oxide and 1% silvadene cream to apply topically https://www.pfizermedicalinformation.com/en-us/silvadene-cream/storage-handling They believe it should be fixed in 5 days. Incidently, in the facility that caused this wound they used Silver Sulfadiazene Creame 1%. I did too initially, but it was unsuccessful. They didn't off load the weight at all. I did. It wasn't great, but it worked. I alternated, or chose the best side for offloading, so she slept on a pillow on her back to off-load the sacrum (lower back) that bears all of the weight. Re-position every 2-hours was the only thing the hospice nurse would offer. Zinc oxide is a nice barrier and I like the choice.

While being cared for, she'll be on an air mattress with a form fitting outer layer. They also have a better way of elevating her feet. Heel lift boots work. A towel and a pillow work, but not great, They are using something that looks the cross-section of a lounge chair. It would consist of the arms and 2-3" of cushion. The pillow is essentially too soft and doesn't have limits of motion.

The hospice nurse was both for and against an air mattress. She said they don't work well when the pt. (patient) is upright. The installer at the facility said the mattress has lengthwise bladders and two different kinds of cushion layers on top.

I'll see if I can locate some before and after pictures of the nasty wound(s). There's a lot of stuff in this thread.

 

[cmartinez]

I forgot what I was going to add to my post, but mom got delivered to a respite care facility that specializes in wound treatment (accidently?). Hey, it was close to the house and they had a bed. They said it wasn't stage one anymore because the blood refills quickly. They said I did a good job and asked what I used.

They are going to compound a mixture of zinc oxide and 1% silvadene cream to apply topically https://www.pfizermedicalinformation.com/en-us/silvadene-cream/storage-handling They believe it should be fixed in 5 days. Incidently, in the facility that caused this wound they used Silver Sulfadiazene Creame 1%. I did too initially, but it was unsuccessful. They didn't off load the weight at all. I did. It wasn't great, but it worked. I alternated, or chose the best side for offloading, so she slept on a pillow on her back to off-load the sacrum (lower back) that bears all of the weight. Re-position every 2-hours was the only thing the hospice nurse would offer. Zinc oxide is a nice barrier and I like the choice.

While being cared for, she'll be on an air mattress with a form fitting outer layer. They also have a better way of elevating her feet. Heel lift boots work. A towel and a pillow work, but not great, They are using something that looks the cross-section of a lounge chair. It would consist of the arms and 2-3" of cushion. The pillow is essentially too soft and doesn't have limits of motion.

The hospice nurse was both for and against an air mattress. She said they don't work well when the pt. (patient) is upright. The installer at the facility said the mattress has lengthwise bladders and two different kinds of cushion layers on top.

I'll see if I can locate some before and after pictures of the nasty wound(s). There's a lot of stuff in this thread.

Very interesting ... now we have a connection of sorts ... I have a 19-year-old daughter with cerebral palsy who's been bound to a wheel chair since she was born that requires most of the cares you've described, and then some.... but back to topic ... as one gets older, the concept, the understanding, and the act of love itself, narrows down to a single thing: In the end, it's what you do that counts... screw opinions, ambitions and ideals.

 

[KeepItSimpleStupid]

Wow! And then some is right!

Anyway, I managed to obscure/annotate a couple of before/after pics. The wounds were there 11/2017 and I'm not sure when i started treating them, but I think it was in January 2018. I need to look at invoices. They should not have happened in the health care facility (11/207) in the first place and I'd like do do something about, but I don't have the time.

I told the hospice aide, that I did not want Zinc Oxide on the stage II wound. I said you can remove the bandage, but do not apply diaper cream to the wound. Hospice agreed that that was OK. At some nursing site, the reaction was mixed observing other people's posts. I would have loved to have tried to pump oxygen to the wound from an oxygen concentrator that was available.

I want the healthcare facilities to document by entry and exit PICTURES of anything unusual. "Take pictures of everything" would be just as good. The before and after pics should be in the discharge paperwork.



Prevention is easier than curing them, Being diabetic makes wound care MUCH harder. I went from Stage II to not stage I, I think, is a pretty good accomplishment with NO TRAINING at all on this one. This is your tailbone.

I was helping to treat skin tears with a home healthcare agency before. When the initial BIG TEAR happened, I was prepared to bandage and I did. I used non-adherent pads, rolled gauze and compression gauze with no wound cleaning. In hindsight, 0.9% saline would be better. Previously, I had been dealing with way smaller tears and not one about 2" x 8".

I reported it to the home health agency that she was under the care of. They used stuff I never heard of such as Medical Honey and Oil Emulsion dressings. That got me to do some research,

That agency did some really stupid stuff. 1) gauze instead of non-adherent gauze to an exhuding wound; 2) No method to secure rolled gauze so it didn't move. I used the stretch gauze sparingly or used Micropore tape which can be used on skin.

Depending on the wound, Skin-prep was also used. This is stuff that makes bandages easier to remove, The skin prep was supplied by hospice as well as medical honey and simple bandages.

Another thing that should be mandatory at the health care facility is nurse call system logging. Systems exist. Response times need to be available to the regulating agencies. 20 min; 2 and 3 hr response times are NOT RIGHT. That's what you get though.

Mom agrees -- I did "help" bring her back from "near death". Hospice helped too. Early on, she was acting dilusional and the nurse was on vacation and I didn't have her cell and email at the time. I checked her oxygen level (SpO2) and she needed Oxygen and she got it because it was available and I had a pulse-ox meter. Hospice said I did the right thing. I also learned that the O2 moisturizer was leaking in the process and got that fixed by calling the durable medical equipment provider.

Hopefully, I can put some more pics together.

 

[KeepItSimpleStupid]

OK, I decided to add another pic before going to bed. This is after a small amount of treatment and debridement (removal of dead tissue). The wound initially was hidden and didn't show the extent of the damage. Both heels are completely healed, but one heel is currently 'boggy' or soft.

Other pressure ulcers showed up when the feet were placed in the heel lift boots. Arthritus has deformed the feet, so naturally the boots don't fit 100% right. Socks or a washcloth was used to offload the areas when being treated and afterwards. These were either pressure against the boots or pressure ankle to ankle.

A towel was used to separate the feet and to support the thighs. Feet separation is less of a problem now.

Facility created because the feet were not offloaded.

The sacrum and the heels are going to be hit hard if you can move a little without offloading.

 

[Nigel Goodwin]

As far as wound dressings go I can highly recommend Manuka Honey - my wife became diabetic, presumably as a result of the severe infection in her foot - she had 13 ulcerated wounds on her foot when she was in hospital. The stupid consultant kept saying that she must have been diabetic for a considerable time, hence the problem - however, their own records and blood tests from a year previously proved that wasn't the case, as there was no trace of diabetes back then.

One of the doctors prescribed Manuka Honey bandages, which they had to order in specially (and didn't like to, because of the expense), within 24 hours her foot was massively better - the difference was absolutely staggering. There was talk about amputation, and I feel the Manuka Honey was all that prevented it - her foot isn't great now, as the bones in her big toe were eaten away by the infection, but it's better than no foot at all.

As for bandaging, some of the nurses in the hospital were good, most were fairly useless - however, I watched and took mental notes of the process

When she managed to 'escape' from hospital (and it was more 'escape' than 'release') they said the district nurse would call every day, needless to say no one appeared and we called the NHS Helpline who arranged for an emergency visit, and then re-arranged the district nurses visits. However, the nurses refused to come every day (despite their instructions to do so), and everyone who came was pretty useless, none read the notes, none did what they were supposed to, and they were all pretty useless at bandaging - but as least we did manage to get them to arrange delivery of medical supplies (although they refused to order Manuka Honey, although the notes specified that).

So I dressed the wounds on the days they didn't come, and re-dressed the wounds on the days they did come - so they got done properly (using the last on the Manuka Honey bandages we brought home from the Hospital) - basically I 'stole' all the best techniques I saw in the hospital, and dumped the crap ones. In fact during hospital visits they complimented the quality of the bandaging

So I seriously recommend Manuka Honey, the silver based treatments were useless, and what the district nurses used - contrary to their instructions.

 

[KeepItSimpleStupid]

I looke don the package of the honey. It is leptospermum honey as the brand Medi-honey.

One of the doctors prescribed Manuka Honey bandages, which they had to order in specially (and didn't like to, because of the expense), within 24 hours her foot was massively better - the difference was absolutely staggering

I totally agree. The honey was great stuff. It seemed to worked really well when it was applied to a new exuding wound. It gave it that healing "kick". Oil emulsion allowed the skin to form without creating scabs. This method worked very well for skin tears. The skin tears were typically on red areas that were damaged. Supposedly, the skin of the elderly gets very fragile. Falls or any pressure would cause these, but the outer layer of skin would not come off. Falls ripped the outer layer of skin off. No oozing blood, just wet. Later, I may show some pics. They are not healed yet.
This is where Microcyn worked wonders. I ran out and quit applying it. 3 liquid oz (~90 ml) is $40.00 USD. The area was too large and I didn't bandage as suggested.

s for bandaging, some of the nurses in the hospital were good, most were fairly useless - however, I watched and took mental notes of the process

Totally agree.

So I dressed the wounds on the days they didn't come, and re-dressed the wounds on the days they did come - so they got done properly

Same issue. Within hours the dressing was off. This was a leg. It required wrapping of gauze. It requires something else to keep it in place than just wrapped gauze.

Compression is important, but it's only important early. It's especially important to attach and compress any remaining skin flap.

So I seriously recommend Manuka Honey, the silver based treatments were useless, and what the district nurses used - contrary to their instructions.

Yep, medical honey. It's really amazing.

The sacrum is a really unusual and difficult place. It always has pressure on it when always laying on your back. The body sweats. Right now, it looks like a bad case of sunburn with minor skin damage. Any layer of skin probably gets abraded off easily. It's near feces. I know offloading is very important. During the healing process, different areas would open up so it was like the skin was superficial.

 

[cowboybob]

I have a generally bed-ridden female friend who had a nasty pressure wound ("hole") near her lower spine. Nothing seemed to help the healing until a medical supplies delivery person suggested a honey based salve (could have been "Manuka" but I didn't see a brand).

Within a few days (with daily replacement of the honey infused bandage) the wound had significantly improved and with a month the wound was entirely healed.

Magic stuff. But sorta typical of the medical staff that none of them suggested it ...

 

[Nigel Goodwin]

Nothing seemed to help the healing until a medical supplies delivery person suggested a honey based salve (could have been "Manuka" but I didn't see a brand).

It's not a 'brand' it's a type of honey from New Zealand - I think any honey tends to have healing properties (and has been used in that way for centuries), but Manuka has better healing properties than others. You can buy it in jars, and make your own bandages - but we had pre-packed medical dressings supplied through the hospital pharmacy.

But it does seem a bit of a 'secret', and most of the medical profession seem to avoid it.

 

[Nigel Goodwin]

Back at home now, here's a couple of pictures of her foot, when it was a LOT better - at one point (before the honey) a young black doctor unwrapped her foot, and he turned green - not an easy thing for a black guy After that whenever he came round again he got a nurse to undress it while he hid across the room.

 

[tvtech]

Nigel Goodwin is like an Angel. I know you will find a cure. You will not stop until you do.
Cause I know you.

God Bless you Nigel.

And I mean that with all my heart.

tvtech

(Ive got all sentimental lately. Feeling aches and pains too)

 

[Nigel Goodwin]

Nigel Goodwin is like an Angel. I know you will find a cure. You will not stop until you do.

The pictures were a couple of years ago, she's fairly OK now, but the foot hurts during changes of weather and the big toe no longer bends - the eaten away bone grows back, but only as solid bone, no joints.

 

[unclejed613]

I have a generally bed-ridden female friend who had a nasty pressure wound ("hole") near her lower spine. Nothing seemed to help the healing until a medical supplies delivery person suggested a honey based salve (could have been "Manuka" but I didn't see a brand).

Within a few days (with daily replacement of the honey infused bandage) the wound had significantly improved and with a month the wound was entirely healed.

Magic stuff. But sorta typical of the medical staff that none of them suggested it ...

my mother was diabetic. when i was about 13 she broke her leg, which for a diabetic is very dangerous, because diabetics don't heal well. however, she later developed a very bad infection on her ankle, which became an open wound. the doctors tried all kinds of ointments and other treatments, and it just kept getting worse. one summer we went to a summer house her family owned, and went to the beach, and she insisted on going into the water, cast and all, just to stand in the surf. fortunately the cast didn't get damaged, but after she came out of the surf, the wound on her ankle didn't look as bad, and within a few days had completely drained and had closed, and the swelling, etc... had gone down. apparently the cold salt water had cleaned the wound out. she eventually ended up with a bit of a scar there, but the "surf treatment" had helped immensely. you never know what's going to help the body heal, and sometimes it's the simplest of things...

 

[MichaelaJoy]

I wonder if Africanized Honey bees produce a honey with very strong antibiotic properties.
I'm pretty sure that in the USA, bees are treated with antibiotics and dusted for aphids.
That's got to have an adverse affect on the natural antibiotic properties of the honey.

unclejed613: When I was younger, if I had a skinned knee, I'd just go in the water at the beach.

It would heal very quickly.

To those of you who are giving care to others, My heart goes out to you.

Blessings to you.

 

[unclejed613]

I wonder if Africanized Honey bees produce a honey

according to a beekeeper i know, africanized honey bees don't produce a lot of honey.