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Original poster

What happens when a leg ulcer gets this bad? Warning, photo attached

78 replies

Fedupandpoor · 24/04/2020 13:01

I have posted before about my Dads leg.

He is 69, has stage 4 cancer and was receiving end of life care in his own home. Since Covid-19 he has not allowed any carers or district nurses into his home as he is terrified of catching it. His leg has gotten steadily worse and I'm worried what will happen. They have tried compression, debrisoft lolly, manuka wraps and packing the wound. He is alone, I am on the other side of the UK and I have two young dc, he won't let me visit or move in with him for lockdown. He chainsmokes in the house also and my DD has asthma so it's not ideal.

Is there an effective treatment for an ulcer this big? The black part is on the outside of his ankle and it's huge. The photo only shows part of the top. The other photo is the inside of the same leg. He uses a wheelchair but can take a few steps with help.

OP posts:
TwinsTrollsAndHunz · 24/04/2020 13:33

Ah, sorry, I missed the post about wound wash and dressings.

SeriouslyRetro · 24/04/2020 13:34

Is it causing him pain? Is he still able to mobilise with the legs as they are?

There comes a point where if he has capacity, he’s entitled to make the choice. But I’d be blunt with him and say if anything’s going to bring death nearer it’s the possible infection in his leg.

Elieza · 24/04/2020 13:36

The black bit is surely the dead but that needs removed. If it isn’t can it not turn into blood poisoning, also called sepsis. That kills. So he has to work out what is the most risk of killing him, the covia19 or sepsis. I’m thinking the latter.
Could you phone the nurses and see if they have full PPE yet, as he may see them if they are sterile?

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BloodyWorried · 24/04/2020 13:37

Our community teams now all have PPE to wear at each patient contact. They will see him, and will help; but he needs to accept it. He can ask for a video call in the first instance (most trusts now have facilities to do this), they can at least give some guidance but it’s going to need treatment in person by a professional so it doesn’t get worse.

Toomboom · 24/04/2020 13:58

He needs to get it looked at ASAP. It has a high chance of becoming infected and getting sepsis, possibly losing his leg and also losing his life.

HappyHammy · 24/04/2020 14:05

When was that photo taken, was it a nurse who took the pic. They may have already tried to help him.

Mummyme87 · 24/04/2020 14:10

As others have said, he needs medical assessment ASAP. The infection in the ulcers will kill him before CV does

FredaFrogspawn · 24/04/2020 14:19

Although the smoking is clearly really bad for him with regards to the ulcer, it does seem to be protecting people from covid19 to an extent - possibly the nicotine? Recent studies show that smokers are up to four times less likely to get serious covid symptoms with the disease.

www.google.com/amp/s/news.sky.com/story/amp/coronavirus-nicotine-patches-to-be-tested-on-patients-after-study-suggests-smokers-less-likely-to-catch-covid-19-11977460

FredaFrogspawn · 24/04/2020 14:20

That may help him decide to see the nurses.

Moreisnnogedag · 24/04/2020 16:15

Ulcers like that are difficult to treat in compliant patients, never mind in non compliant patients.

If the district nurses are dropping stuff round I am sure that they are continuously having the conversation about refusing medical treatment. At the end of the day he is I presume a competent adult, has made his choice and you need to find a way to live with it. Maybe ask him not to send photos of his ulcers unless he is wanting you to act on it?

Original poster
Fedupandpoor · 24/04/2020 17:50

Oh God this worrying me Sad Wtf would I even do if the worst happened? I wouldn't even know how to get across country right now with two dc in tow.

I'll speak to him tonight. He's a belligerent old sod though and will argue black is white.

OP posts:
HappyHammy · 24/04/2020 17:52

Did he send you the photo.

Elsiebear90 · 24/04/2020 18:01

The black one is necrotic and without treatment will more than likely become gangrenous and again without treatment will lead to sepsis and/or amputation. However, if he has capacity and refuses treatment you can’t do anything. I would emphasise that in his current condition he’s more at risk from an untreated necrotic ulcer than Covid, can you order him some masks? Would that him more comfortable letting people in to see him?

Dowser · 24/04/2020 18:26

It also looks like he has cellulitis
He does need professional help

Terralee · 24/04/2020 18:32

I'm sorry I'm shocked by those photos. Looks necrotic & he's at high risk of gangrene & sepsis.

Tell him that if he's scared of dying then put bluntly he has to accept treatment now.

Some people with capacity do choose not to get gangrenous leg ulcers treated by dressings, or by amputation as a last resort & die in hospital or at home of sepsis.

Your dad will have some decisions to make & quickly about what he wants for his future.
At the least he needs to see a gp, preferably to present at the nearest ED.

I do understand what it's like to have a difficult relative with capacity as I have had issues with close family & I really feel for you, I'm so sorry that you are going through this.

Quartz2208 · 24/04/2020 19:49

Oh OP yes I think you are going to have to because the chances of him dying if that is left untreated (and I suspect he may well need to go to hospital now to have iv antibiotics) is fairly high.

piratehooker · 24/04/2020 19:59

Bless you OP. Apologies if you've already said (am trying to read without my specs on, and it's not the best idea!), but what is his take on his ulcers? Does he understand that compression, cleansing, dressings etc., are what is recommended, and crucially, what the consequences could be if left unchecked?

What does he want to happen, and/or think will happen if he continues to refuse any professional input? What are his goals for his future/treatment, or lack thereof? It's very easy, and natural, for us to assume that everyone would have the same goals (i.e. to cure an ulcer). For the patient themselves, it might actually be all they want is to be able to put their favourite shoes on, or so long as the pain is controlled they're happy.

The 'where do you see yourself/your legs/your health being in 6 months' time if we don't try xyz' is a conversation I often have with patients who (understandably) don't want compression bandaging and/or other care given, and often it prompts them to think beyond just 'hoping for the best'.

BernardoTeashop · 25/04/2020 07:31

I don’t mean to alarm or worry you but an 89 year old family friend died last week of the infection caused by an ulcer on her leg. You need to convince him to get treatment. Best wishes and good luck x

LadyEloise · 25/04/2020 09:17

Why is his GP not involved ? Fedupandpoor
I'm in Ireland so I don't know how GP care works in the UK.
In Ireland people aged over 75 have free GP care and the doctor would go out to the patient and take it from there.

EarringsandLipstick · 25/04/2020 09:52

LadyEloise OP says clearly that her dad won't let anyone in.

(Also, slightly surprised you're not aware that in the UK it's entirely free GP care. And I'm in Ireland too.)

Quartz2208 · 25/04/2020 10:01

@LadyEloise because he wont let anyone in. The OP says it has gotten steadily worse so presumably pre CV it was managed by district nurses

LadyEloise · 25/04/2020 10:15

EarringsandLipstick I know that people have free GP care in the UK but I wasn't sure about call outs for GPs.
I know in the UK it can be very difficult to get a GP appointment, whereas I can get a same day/ next day appointment- but I don't have a medical card and pay €65.

My Dad's ( health issues- not mobile ) GP will come to see him if required - free home visit- It is a small suburban practice with just the one GP.

Fedupandpoor
I don't envy you. If he won't even see a doctor I don't know what you can do.

notapizzaeater · 25/04/2020 10:22

If he's stage 4 cancer is he known to your local hospice ? They might be able to advise ? Our hospice are in regular contact with DH (stage 4 cancer) to make sure everything's ok.

JustStayHome · 25/04/2020 10:29

That is infected and needs IV Antibiotics

If left this will lead to sepsis, Sorry OP.
But he needs hospital NOW

vdbfamily · 25/04/2020 10:56

If he has capacity, this is his choice, but if he is afraid of dying, someone needs to clearly articulated to him that ignoring his ulcer care has a higher chance of hastening his death than a visit from a DN. If he genuinely understands this and still chooses to refuse help, that has to remain his choice.

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