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Venous leg ulcer - refusing too heal(13 Posts)
DM has had a leg ulcer for approx 5 months that is refusing to heal and becoming increasingly painful.
It is a venous ulcer and exacerbated by lymphedema. She attends a clinic for both conditions but it doesn't seem to be making any difference to the ulcer. In fact any treatment by the ulcer nurse leaves DM in agony.
Given the times we live in it is likely that I will soon be caring for DM and would like to know how I can best treat the ulcer. Just dressing it by the nurse seems to be making zero difference, and causes agony when it's cleaned.
They are desparetely difficult to treat.
Such things need treating and monitoring by medical staff; it is not a task for the lay person. Does your mother under the care of a district nurse or specialist clinic at hospital.
V. difficult to clear. My mum, nursing sister of 50 years, sorted my auntie out with frequent dressing changes and salt water/glucose solution (for leg not orally although hydration is important). She sprayed this on at intervals with a spray bottle thing like you use for plants. But as previous poster says, preferably follow trained medics instructions.
Has she had a Doppler to determine it's a venous ulcer as opposed to arterial? Is she in compression bandaging?. This is often the only thing that will heal them. I was a district nurse for 14 years and some people had ulcers that were ongoing all that time!
Diabetes, smoking, lymphoedema etc will all complicate matters.
So she is diabetic, obese and previously suffered severe cellulitis (all the goodies!)
Doppler has confirmed ulcer is venous.
I visit every day to do the strappings (as instructed by lymphedema clinic) but she can't bear the pressure on the ulcer. She visits a "specialist" ulcer nurse once a week but sees a different one every time and says that they don't even seem particularly competent, creased strappings, poor dressing of wound etc. Even worse she says some are really rough with her leg when cleaning the ulcer leaving her in terrible pain. Wouldn't be so bad if it actually helped the healing but it doesn't
You shouldn't really apply compression bandaging unless properly trained and it shouldn't need changing every day? Who has decided that?
District nursing is on its knees, they probably struggle to staff the clinic at all with those appropriately trained, I know we did, so seeing a different nurse is likely unavoidable. They will have tens of people on their books like your DM.
She needs to speak with her GP for stronger analgesia to take prior to dressing change and consider a referral to the vascular team or a tissue viability nurse if it's not improving. Her diabetes needs to be well controlled and weight loss will help. Be warned though, despite all efforts some ulcers IME never heal.
The lymphedema clinic have said compression wrappings need to be done every day. There is no resource for a district nurse to visit everyday and it's not safe for DM to drive in her current stage so it falls to me (medically trained or not!)
My DH developed a leg ulcer last August. We did have brilliant treatment from the practice nurse. She saw him twice a week to start with. Doppler result was not too good so referred to vascular surgeon who didn't seem too concerned. Back to practice nurse. DH couldn't tolerate pressure dressings so it took longer to heal. They tried different treatments and dressings and we got there in the end by Christmas. They gave me good advice re washing his legs everynight with a special liquid soap called Epimax, washing that off and then applying Diprobase. I think the Epimax has really helped as his legs were so scaly and dry before. He's also diabetic. Hope your mum's heals. They are horrible, difficult things to clear up.
Sounds very similar to my DM bananaskin. She can't bear the pressure either and her legs/feet are incredibly scaly, despite me constantly rubbing flexitol in them.
It's crazy that such a tiny mark on her leg can cause so much trouble! It appears to start healing but then weeps again. Says it feels like hot acid is being poured down her shin when any pressure is applied.
Thank you for the product suggestions, I will ask if they have been mentioned to her.
There is no practice nurse that offers ulcer treatment. DM has to go to a clinic 15 miles away and gets seen once a week
Hi, another district nurse here, sounds like she needs to be in compression bandage system such as actico? Does she go to bed at night and elevate her legs in the day time? This makes a huge difference. We had a person who had ulcers who had ulcers for 10+ plus years but kept their legs down all the time, became bed bound due to illness and legs healed within a month. Actually can think of more than just that one case. Also has she had a recent swan to check for infection, is her pain management under control so she can tolerate the compression better? I would be asking if the DN can call at all.
I'm a practice nurse and no, we don't do leg ulcers, general practice not 'paid' for that.
As a DN if you hadn't been available we would have to visit, just have to. I would worry this isn't sustainable for you.
Unless her leg is very wet I would query whether it really needs daily dressings.
Firstly, so sorry to read your story, it sounds like you’re trying your absolute best - genuinely, well done as it’s tough. What cptartapp said is 100% correct. Unfortunately access to healthcare is a postcode lottery when it shouldn’t be. Your DM needs compression but it must be applied correctly for pain management and efficacy. Poorly applied compression, unfortunately can cause harm. Push for an a referral from her GP to www.Dorset healthcare.nhs.uk/patients-and-visitors/our-services-hospitals/physical-health/tissue-viability-wound-management as the Lymp clinic are not experts in wound healing. However, appreciate this maybe tricky during the current climate so hang on in there.
You could also try the Lyndsay Leg Club who usually operate specialist Leg Clubs across the UK and do have centres in Dorset. And while I don’t think it will be possible right now, you could also seek, if the wound is becoming chronic, a referral from her GP to Accelerate CIC, they are based in London but are experts at treating wounds that nobody else can support.
I should say, I’m not a medical professional. But I am affiliated with Legs Matter, legsmatter.org/ and legsmatter.org/legs-matter-week/stories/ They’re a coalition of organisations who are raising awareness about issues exactly like yours.
Best of luck and I hope you both get the support you need.