My mum has a leg ulcer and a DVT; so what happens now?

[KatyMac]

She had in insect bite in August
It kept getting infected
From October onwards it has been dressed 3 times a week (with silver, honey & all sorts)
She had a referral to the hospital about 3 weeks ago & referred for a scan on Thursday

Then today they decided she had a DVT - & at the EADU they agreed, gave her an injection and told my dad to give her an injection, tomorrow & Wednesday and come back for the scan on Thursday

So, what happens now?

Bump cos I'm feeling a bit stressy about this

My mum isn't old!

Hi. Sorry to hear this. I can't help with the ulcer aspect but hope someone will be along to tell you how that impacts treatment. The DVT I had in my leg was initially treated with heparin in a drip in hospital and then with Warfarin tablets at home. The irritating part was the frequent blood tests to ascertain the correct dosage to keep me at optimal clotting level. This went on for 6 months. By the end the blood tests were only weekly.

Thank you

Is it a kind of forever type treatment or might she 'get over it'?

No, the treatment was totally finished at 6 months. I do have to let doctors know that I might have a tendency to DVT and as a result I am careful with support stockings on flights and with keeping hydrated etc.

Good luck

It seems to be totally connected to the ulcer & infection which is currently blue/green (delightful)

There are new alternatives to warfarin now. they are not suitable for everyone, but for short term treatment for acute DVT this might be a possibility for your mum, op.

nemno - that was bad luck (and unusual) only getting to weekly tests at 6 months.

Yes, you have my sympathies with that, my mum and her mum before her were plagued with leg ulcers.

She is having a daily injection in her tummy

3little frogs sorry, yes, that was misleading, I was on weekly tests well before the end of that period I just can't remember when exactly.

KatyMac support hosiery will be very important in your mum's future care to prevent further ulcers/DVT. The NICE guidelines support this.

They've taken her elastic bandage off and told her not to wrap it (apart from the dressing)

She was supposed to be having tight from knee to toe but that stopped today

The tight toe to knee bandages are most likely compression bandaging which is usually used following a test (called a Doppler) of the blood circulation and these tight bandages are used to improve circulation to help the ulcer to heal if the Doppler results show this to be the correct treatment.

Compression Bandaging should not be used when the Patient has an infection or a DVT.

(I know this from working as a DN).

Your Mum will probably be started on Warfarin and the daily injections can be stopped once the Warfarin Blood levels are correct. Usually the Warfarin continues for six months and is then stopped if no other blood clotting problems are identified. If she has another DVT she will be given more Warfarin for six months or maybe longer if needed.

How about healing the ulcer?

Very difficult to say without seeing it!

Is your Mum on any Antibiotics? Has anyone taken a swab to check what the infection might be? Was it definitely an insect bite? If so do you know what type of insect?

Once the infection and DVT are cleared the ulcer should heal, whoever is changing the dressings can change treatments (use different dressings) until compression can be used again if needed.

Where is your Mum having her dressings changed at the moment?

I'm sorry - it's so upsetting as my auntie had MS & other problems & ended up having both feet amputated

Is your Mum on any Antibiotics? Yes - Flucoaxacillin (I think) always the same one
Has anyone taken a swab to check what the infection might be? Lots of times

Was it definitely an insect bite? If so do you know what type of insect?
She was bitten in Spain in August - we assumed a midge bite

It keeps getting infected this is about the 6th lot of antibiotics & it's being dressed at the surgery

Ex DN here too.

Presume your mum has been checked for diabetes?
Does she smoke?

Both can impact on wound healing.

No diabetes - yes she smokes

I too was wondering about Diabetes / Smoking!

Katy does your Mum have any other medical things going on or other medication she is taking?

The only other thing I can think of is with it probably being something from abroad it may be another type of insect or just that there is a small part left in the wound and it needs properly cleaning out by the Hospital. It may be worth asking the GP for a referral to Dermatology maybe?

I hope you and your Mum are feeling better soon x

...or referred to plastics for surgical debridement if wound is chronically infected??

The smoking will most likely have played a significant part in her DVT and increases her risk of recurrence, and will also mean delayed healing time.
Of all the leg ulcers I have treated over the years, apart from diabetes almost all belonged to smokers or ex smokers.
Good luck.

She has HRT I think & pernicious anaemia which she has an injection for but that is all the meds before this.

She has a bypass about 5/6 yrs ago but that turned out to be because her Aorta/ femoral arteries were damaged in a previous op (laperotomy) 30)rs ago

She is feeling a lot better today

Thanks guys - I was panicking

Apparently they gave her the 'wrong sort' of scan yesterday

So she has to go again today to have the 'right sort' of scan which she should have had as an emergency on Monday