Followup: tissue infection

[KnottedYet]

One of my coworkers had a hysterectomy and the site got badly infected. Her doc took out the stitches and had her pack the wound with honey (plain ol' off the shelf honey). The sugars concentrated in honey dehydrate and kill bacteria. She changed the wound packing every day, and said she could watch it healing from the bottom up.

We had a dermatologist in town who had folks pack excision sites with plain ol' table sugar for the same reason.

[mimitabby]

Hip, drag yourself down to the doctor and camp there until they let you in!
There are frequent cancellations at every dr office!
these things can KILL you!

please please please!

Mimi

[HipGnosis6]

My dr. appointment was on Monday. She said she thought it looked better - and then measured the ulcer and decided to prescribe another run of antibiotics. She gave dire warnings about what would happen if I didn't make the time to soak the wound daily, etc etc. I asked her how I should go about doing that in a bus station loo.

As Knotted mentioned and as I'd run across when researching what exactly was wrong with my leg, the evidence is both plentiful and reputable that honey really is good for wounds. Unpasteurized is better than pasteurized and certain plant sources seem to make it even more effective. The catch here is that the act of actually dressing a wound that's 3 inches across and two inches high and a 1/4 deep in the shallowest part with a honey dressing is more than one can really manage in the ladies' room at work. If it's not doing any better I might give it a run during winter break from school, though.

I'm a full time student and must also work full time to keep a roof over my head. I can't go to the Providence Wound Center; it would cost me tons of time and money I don't have. I don't have health insurance and because I'm temping my income for the last 90 days is too high to qualify for any sort of aid or discounted care. This sucks.

[Bikingmomof3]

I understand you have a hectic schedule, but if you do not find time to care for you, who will? Your health is vital. Please find a way to fit in the soakings as prescribed by the doctor. I am sorry you are going through this. I do understanbd the financial side, I have been there. It does not seem fair, I know. Please, for the sake of your health, take a few moments in your day to soak the area. Things could turn badly as your doctor told you, then you would not be working or going to school.

[bcipam]

Get this problem taken care of as soon as you possibly can. And get tested for diabetes. You want to keep your foot!

A former coworker of mine was diabetic (and an alcoholic - as you can imagine this story won't end well) and he got a bruise on his foot from dropping a bigass Folgers can on it. That turned into an infection and he didn't manage it very well. Over the next two years they eventually shortened his leg up to the knee in about 4 different increments. He died of other diabetic-related causes a year ago.

Dianyla I was thinking of the same thing. Have seen this happen to several friends.

Please take this very seriously. A wound that does not heal, especially on an extremity is very very serious! I would try and locate a wound specialist as soon as possible!

and BIG HUGS YOUR WAY HOPING YOU GET WELL SOON!

[KnottedYet]

2 inches by 3 inches!!!! That's bigger than the last time you posted the dimensions!

Do what the wound care chickie said! You risk amputation if you don't get this under control. This isn't something you can just put aside until your winter break.

If you have to, take a basin/bucket in to class and soak there. Soak between classes. Find someone at school (student services) who can hook you up with the resources so you can treat your foot.

[Xrayted]

Hip, hobble into that office and don't leave until someone takes a look at that foot! I mean it, woman! This is NOT going to go away on it's own. They just get worse. Believe me, you do not want this to get any worse. There's a nurse I work with who had this happen, got superb treatment and still lost part of her foot/ankle and had major skin grafting. I too have heard the honey thing works but don't use it as a substitute for getting to the doc.

Let us know how you're doing. We all care about you.

[mimitabby]

And we in the "home of the free and the brave" don't have health care for our children.(But we have the most expensive embassy in the world in Iraq)
Does that suck or what?

[Dianyla]

I'm a full time student and must also work full time to keep a roof over my head. I can't go to the Providence Wound Center; it would cost me tons of time and money I don't have. I don't have health insurance and because I'm temping my income for the last 90 days is too high to qualify for any sort of aid or discounted care. This sucks.

From my personal experience, I can assure you that Providence is very good about charity health care. If you can prove that you have limited (or zero, in fact!) ability to pay, they will work something out with you. This link explains more.

Keep on it, whatever you do.

[HipGnosis6]

I called to talk to the people at Providence about the wound treatment center and they set me up for a phone consultation this afternoon - the guy I talked to was really helpful and talked about what I should actually be doing to care for my wound and what to worry about or not worry about. Since my sugars test as normal, I need to worry most about infection and the area of redness around the wound should be watched carefully for spreading there as well as keeping an eye on the ulcer itself. If things got worse I wouldn't need to have my leg amputated at the knee, but I could lose a chunk of my calf to surgical debridement.

He also reassured me that the increase in the size of the ulcer isn't necessarily a bad thing - if there was a ring of dead skin around its opening, that would have been slowly removed by the wet-to-dry dressing technique that was reccomended before. The fact that the bandages were becoming painful to remove is a positive sign in that respect. There are live nerves at the edge of the wound and that is GOOD. Ouch = living cells. However, that kind of physical debridement can also disturb the healing cells, so instead of pulling off the dressing dry, I should soak it if it's sticking.

I asked about honey dressings. The doctor said the same thing a few of you have said - I'm welcome to try it but I should also continue taking the antibiotics as prescribed by my Dr. at the clinic.

The wound center's indigent care program is about the same as country doctor - to qualify for free care you can't earn more than 50% above the Federal poverty level, which is around $8k/year for a single adult. Well, I make about double the $12/K a year they need to provide me with free care and that's enough to exclude me from discounted care as well. But they were kind enough to waive the fee for the phone consult today, so that was nice of them.


Experiment 1: Soaking tub

I obtained a kitchen trash can that measures 11x14 at the bottom and 18" tall. Lucky me, this is about the same height as my desk chair. Filling it proved easy, since the tap in the bathtub is higher than that. Moving it somewhere usable proved.... doable, if a little sloshy. A good "Fill Line" got marked on it (I tested it out to make sure it covered the appropriate area and didn't overflow the tub). I hauled it out here and set it on a towel. It worked out well. Tomorrow we will figure out how much epsom salts to add.

Experiment 2: Honey dressings - this weekend

Manuka honey is the most effective but is hard to come by in the US.... or well, it's easy to order but for the price I could just go to the doctor. Unpasteurized honey of any variety also works but needs to be changed more frequently to keep from being overdiluted by the fluid oozing from the wound. My particular wound is oozy, but not like it was - I was cutting a maxi-pad in half and in six hours it would be pretty thoroughly soaked with yellow goo. So... the trick is to figure out how to make a honey dressing that will effectively hold the honey in place without access to expensive occlusive dressings and without ruining my slacks.

The answer so far is to apply the honey to the inside of the dressing sponge and tape it on. On top of that, a secondary dressing made out of a square of lightweight vinyl will be put in place to act as a water- and honeyproof barrier. I may also wrap this with athletic tape, but that's maybe overkill....

[pll]

{{{Hip}}}

This situation awful and scary. Please be careful with the wound dressing - I read you mentions of vinyl and athletic tape with trepidation.

It sounds to me like you should qualify for the Providence sliding scale (http://www.providence.org/resources/...dingScale.pdf). The 2006 federal poverty level is $9,800 for a one person household, so someone earning $26k still would qualify for 70% charity sponsorship.

Take care.

[Bikingmomof3]

(((((((Hip)))))))))

[KnottedYet]

I don't like the vinyl or athletic tape ideas either. Please talk to the Providence wound folks again before you put anything non-breathable or constrictive in the area.

Even the commercial occlusive dressings are breathable to some extent. Can you change dressings more often rather than trying to keep an old one on after it is soaked through?

[doc]

HG6, I feel so bad for you. This is a terrible predicament you are in. But like everyone else said, that ulcer needs close and frequent follow-up. I am worrying about your leg/ankle alot. As far as the honey goes, it should be applied fairly thickly. Enough so that the sugar totally overwhelms the bacteria.

A gross but true fact, maggots are fabulous for helping to keep the type of wound you have very clean and aid tremendously in healing. I don't think you can get anyone to actually give them to you, but this has been studied repeatedly and is known to be true. I guess no one can bring themselves to actually putting maggots on another human being on purpose. Here are 3 of a zillion reports about maggots.

http://www.webmd.com/content/Article/94/102721.htm

http://www.abc.net.au/science/k2/moments/gmis9814.htm

http://www.wellcome.ac.uk/doc_WTX024102.html

[HipGnosis6]

The problem with occlusive dressings that are available on the consumer market is that I can't buy one that's large enough. I figured out how to order them on the interweb, but they're much too expensive to even consider. The same with burn dressings, which are designed to be wet - I COULD get them, but they aren't really readily available to the average consumer and are outrageously expensive.

I don't like the idea of saran-wrapping my wound either, but I'm having a hard time coming up with any better plan. I don't know, w/p/b yardage maybe?