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

[Fedupandpoor]

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.

There really isn't any useful treatment for this. He is refusing treatment and he is still smoking - the ulcer will never heal I'm afraid. It will be there until the end. I've treated many leg ulcers and even if the person is accepting treatment, ulcers like this don't ever get better. I'm sorry but that's the truth.

how are you doing OP? I hope you're coping ok.

Hello, thank you everyone for your advice and @Mrsmorton checking up on me.

Last night we spoke and I told him everything I have read here. He didn't say much, but this morning I got a very long message about how any medical professional he let's in the house will tell him to go to hospital and he will absolutely not do that. He's afraid he will not come out. He said I can speak to his gp if I want, but that we have to come to a solution "that works for him". He is a VERY difficult person.

His gp is fantastic but obviously can't do anything if dad won't let him in. The hospice people came years ago but dad was very aggressive and they stopped coming.

So, I guess there is nothing I can do. Dad seems to think that there is some sort of cure available that he can do at home but the nurses are withholding it. He keeps messaging me to do more research and find out what it is. This is him at his most reasonable by the way. After the last round of chemo he was given a massive dose of steroids that he took for too long and ended up with steroid dementia syndrome. That was perhaps the worst year of my life, I honestly don't know how people cope with caring for loved ones with dementia

So sorry that this is so tough for you and your dad. I would contact his GP though - if they are used to your dad, they might have a way to try and sort this out!

Oh Fedupandpoor I saw your latest update.
I'm so sorry that he has declined medical help.
You've done your best.
It's not fair on you.

I’d defo contact his doctor. He may not be in full possession of his faculties and there may be some way of doing what’s best for him? I doubt it but you never know.

It’s a hard situation for you to be in. I’m sorry

Dear God! You poor thing. Going into hospital is v v unlikely to kill him. Leaving his leg like that for much longer very well might.

He's refusing medical help, still smoking (?) and eating a shit diet which won't help his blood supply.

He needs to seek medical help - at this point, I'd consider A&E.

Hi OP. So sorry you are going through this. Please speak to the GP. I agree they can't do anything if he has capacity to decline help but they can listen and know about what is happening if he becomes more unwell
and needs help. They can help to shoulder your mental burden. They will be able to discuss him in MDT meetings with social services and nurses and hospice team and just be aware. They have seen and dealt with this before. It WILL come up a head one way or other when he either becomes too unwell to make his own decisions or decides he does need help. The professionals knowing you and knowing the background will make that immensely easier.

The gp is aware of the ulcer. As he is on end of life care, the only thing they really offer is to make him as comfortable as possible. When he had dementia I managed to get the gp to do a home visit, but he told me as he left if dad refuses treatment then there is nothing they can do.

I'm sorry I'm not trying to be difficult and refusing advice. I know he needs medical attention and urgently! Is there anything at home he can do? I told him to continue with the debrisoft lolly to remove the dead tissue. He's also getting out in the sun for half hour a day and using his SAD light.

6 months ago we almost lost my mum to sepsis from a leg ulcer, and it wasn't half as bad as that.
Unfortunately chronic ulcers like that don't just go away If you rub a jar of honey on them. They need careful regular management. My mum has nurses in 3 times a week to change her dressings, she's in the at risk group but shes more afraid of developing sepsis again than nurses bringing CV into her home. Even if your DF manages to get through the next month/s without sepsis he'll very likely lose his leg. That's a mess.

I was a district nurse for fourteen years and dressed the same ulcers for some people all that time. Your DF's ulcer is unlikely to ever heal, his circulation is probably shot and with poor nutrition and continued smoking you're on a hiding to nothing sadly. All the dressings in the world won't cure it. It's pretty common actually. Costs the NHS millions.
It really still needs ongoing professional monitoring though re infection, but that seemingly will prove more difficult.

Just thought I'd give an update to this thread.

No luck getting Dad to allow the nurses in, but I have found some silver infused wound dressings that have good reviews for venous leg ulcers. We're also looking into low level light therapy and if it's possible to try that. A wonderful person messaged me to suggest medihoney which I have ordered off amazon along with the silver dressings. I'll let you know if anything brings results

Hi OP,

Previous community nurse here. Please see if you can talk to his district nurses on his behalf.

Unfortunately ulcers at this stage, on a smoker with poor diet and other serious health conditions are very unlikely to ever heal. The cause is related to his circulation, the wound is a result of that.

I would really advise against buying dressings online.
Manuka honey in particular can cause an increase in wetness and macerate the edges of wounds causing further breakdown.
Silver impregnated dressings tend to be ineffective in leg ulcers.

I wouldn't necessarily assume it is infected. Surrounding skin of venous ulcers is often very red, inflamed looking due to poor circulation. Have his nurses/GP seen the pictures?

The only real treatment at this point would be surgical, which they absolutely wouldn't do with him having stage 4 cancer.

What he really needs is a Doppler and proper compression bandaging, however if he won't accept this:-

-Keep the elevation as much as possible - so him lying down or fully reclined in a recliner. Just having your foot on a stool is not enough, foot needs to be above heart level.

-Keep it as dry as possible. His nurses should advise on best dressings to do this and frequency of changing. If bandages have any strike through(fluid that has come through) change them straight away.

-Improve diet at much as possible, he will be losing a lot of protein. Ask GP about fortified drinks.

-If your dad would be willing to re-engage with the hospice team (over the phone) they would be the best people to advise about pain relief. Venous ulcers are often not as painful as they look, thankfully, but there are lots of options to help discomfort.

Horrible situation, I really feel for him.

Jesus that is grim. Not much gets me going in sporners corner, only once or twice in years of MN.

But really. That can't be right, can it?

I'd get a LIVI appointment with the Gp. Show gp the photo. I'd want it recorded.

Don't bother buying dressings off the internet OP. There are no magic dressings when you get to this stage. As a pp said, compression is usually your answer, even then it can take several months if not longer. I hate to be so negative but really, you're wasting your money.

Sounds like excellent advice from Pingu

How are things now OP?

@EarringsandLipstick He was due his injection today that he gets every 3 months. I'm not sure exactly what it is but it's to suppress testosterone after prostate cancer.

He let the district nurse in to do it, but had a bit of a moan as they came two together. He mentioned his leg but (he said) they didn't seem very interested. If it's true, they've probably had enough of him to be honest. I know they have him down as abusive in his notes.

He gave them a shopping list of bandages and dressings that he wants and sent them away. He's so fucking difficult. He wants a magical cure, how he wants it, when he wants it, and a global pandemic is not a good enough excuse to not obey 🙄

@pinguwings Thank you for the amazing advice, everything you said makes sense.

God fedup it must be so hard, wanting to help but not being able to (because he won't let anyone help). 💐
Hopefully pingu's advice will help a bit x

Not much help here. But I am a patient with severe leg ulcers. I was told about 5 6 weeks ago to start looking after them myself, wound care and infection control only. I have been in compression about 18 months but not able to do that myself. The nurses did not feel it was safe to come into homes at that point. But they have restarted this week. They can come to him in masks and gowns to treat him but I have offered to go to a center rather than have them in the house.
The nurses are returning to the patients in their own homes and doing it safely y now.
He has very little to worry about on that side of it but he really needs treatment. That must be so painful for him on top of all his other worries.
With the silver dressings the nurses can supply those too. Don't spend loads of money on buying them. They can make sure he gets the right type.

Would he use one of these? www.huntleigh-diagnostics.com/_assets/img/PDF/Hydroven%203%204pp%20Brochure%20779345UK-1.pdf

It's a difficult situation OP, and at the end of the day is he has capacity, then he is well within his rights to refuse care.

Try to reassure him that contacting the GP/DN team does NOT mean he has to go to hospital - even if that is their advice, they cannot force him to go..it equates to kidnapping him.

My grandad had awful ulcers on his legs last year and he responded very well to the silver dressings, but they're not a cure all/won't work for every patient.

Ideally he at least needs to let the nurses in to dress his legs - may need another referral through the GP to the team though to add him to their redressing list.

There is no quick cure for ulcers, and indeed they may never fully heal, but it's about infection prevention, trying to avoid an infection in the wound which could develop into sepsis, and trying to promote healing as much as possible.

Ffs, he's now managed to overdose on his oxycontin. He should be fine as he has built up a tolerance but he really shouldn't be living alone. He won't accept anyone moving in with him and will not leave his house. Elderly parents are worse than kids sometimes