Ulcer on elderly leg - any experts here?

[GarlicJuneBlooms]

Mum (85) had varicose veins stripped out (twice!) following her pregnancies. One of the remaining veins in her shin has developed a persistent ulcer. She's had it for ages - well over a year - and is now on repeating antibiotic cycles, with silver ointment on the wound. She is very active, but pain from the leg is now severely restricting her mobility. She now takes paracodol all day, with ibuprofen as well at night. She's normally averse to painkillers, so it must be agony! It hurts to touch the area at all, so I can understand her utter terror at having to wear a compression bandage again. She's going for a fresh doppler test next week.

I know these things are notoriously hard to shift, but am hoping there's some treatment regime her doctor hasn't thought of? It's upsetting that she's fit & well in all other respects, but so miserable and hampered by this one thing.

Take her to medics. Painkillers won't take an ulcer way, it needs removing. (I'm not a medic)

Don't drop it either,
one for you and one for mum

Thanks for the flowers, Monty :) She's being treated at her GP surgery, they haven't sent her to see anyone at a hospital. I guess I'm hoping a Mumsnet expert could point me to a more assertive treatment, with evidence I can print out for her to show the doc! Perhaps she's right that "they can't do anything" - terribly sad, if so.

When my Dad had a diabetic leg ulcer the District nurse dressed it with manuka honey dressings, not sure if every surgery does them but might be worth a google. It healed quite quickly once they started using that.

Have the swabbed it for 'antibiotic resistant bugs'? It could explain why it's not healing

Compression (if suitable) is the best proven treatment for healing chronic leg ulcers. The pain should subside once it begins to grow granulation tissue as the nerve endings will no longer be exposed. Hope she gets it sorted soon, leg ulcers are nasty things.

another vote for honey

and

I'm not sure what the medical opinion is, but I have heard of people visiting hyperbaric chambers as a treatment. They are also used for people with MS, so you might be able to find out if there is one in your area through that route.

I've no idea if there have been proper studies though.

Oooh, thanks! I will definitely ask about the resistant bugs, Sybil. She did have manuka honey dressings at one stage, but now she's on silver (nitrite, I presume.) I'll also find out about hyperbarics and try to reassure her about the compression bandages - though I'm pessimistic on that front, they really give her a lot of pain :(

Agree, compression is the way to go healing ulcers, simple dressings alone can take weeks or months, some never heal at all. Ulcers can't be "removed". Presuming she is not diabetic or a smoker, both of which can delay healing massively.

No bad habits or diabetes :) My reading suggests the bandages hurt so much due to infection, not the ulcer itself. I'll try talking this over with her and suggest she pushes for more analysis of her wound. I've just been looking at maggot therapy - but if I were to mention that, she'd try doing it herself, which might not be the best idea!

Thank you all - I'm getting better informed all of a sudden

Dear OP,
Leg ulcers can be complex and can be very slow to heal. As this has been going on for a considerable period of time I would suggest insisting on a referral to your local specialist leg ulcer clinic. This could be based in the community or your local hospital. A comprehensive assessment is needed which will include identifying if it a venous or arterial leg ulcer (which is why they are doing the Doppler), a holistic assessment of your Mum's health and lifestyle and also looking at things like antibiotic resistance. If it is a venous ulcer then compression bandaging is by far the best treatment. Honey can be useful for infected wounds as can maggots. It might help(or not!) to tell your Mum that the maggots will be in a little "tea bag" and won't be loose on her wound. Until a comprehensive and holistic assessment is undertaken by an expert then there is little point in them jumping from one treatment option to the next. Good luck x

Thanks! I still think I'll keep the maggots to myself I hadn't heard of leg ulcer clinics - something else to investigate.

Was about to type the same as princess they may also want to biopsy it to check the skin is ok

Hi. My mum had a leg ulcer which was very painful. After a while she got sent to a consultant where they did some tests and decided it was arterial, due to blocked arteries rather than venous, due to blocked veins. They said that if it didn't heal they would do a bypass surgery.

My mum stopped smoking although she hadn't smoked that much. I also got her vitamins and antioxidants plus zinc and a cd I ordered from amazon. I can't remember the name and it may have been american but it was based on diabetic ulcers and was about visualising blood flow to the area. Not sure if it was due to any of this but it cleared up completely and shed hasn't had another one.

& my mum had the leg artery bypassed (at Easter) & her Ulceris well on the way to healing

When I had a leg ulcer I found the nurse mush more skilled than the GP. He gave me antibiotics and told me to keep it covered.

Practice nurse explained about moist wound healing with gel packs and a daily regime. It cleared up quickly with her help. Or your Mum may benefit from seeing a tissue viability nurse.

Call the gp surgery and get the number of the tissue viability nurse specialist. These buses are highly trained in ulcers, and have the latest products and info right at hand, they should also do community visits. The GP may be trying his best, but if he's not quite up to date with training, he may be missing something. There's no way she should have had this for 12 months if she's prepared to do all the right things. And don't underestimate the pain, venous ulcers are the most evil pain ever.

Good luck x

*nurses. Not buses ??

Seems really poor that it's not being regularly treated by district nursing team to home or by a clinic .
Yes nurses know lots more than GPs about treating ulcers . Though continuity of person treating it is also important .
Also really poor that it's not been swabbed .

My mum ,in 90's ,has leg ulcers and they do take ages to heal - a year for one . But she too resisted compression bandaging .Which is her right .

I think key is keeping leg elevated ,healthy diet ,continuity of care . Not one nurse who tries something one week eg honey and another who tries something else eg inadine the next .

Sounds like she's not been given proper care . Tell her to keep leg up .
If you can't get a leg ulcer clinic or tissue viabilty nurse ( like golddust in SE london ) jump up and down for regular DNT visits.

Your poor mum .And poor you .

Wow! Thanks for all the help and advice

I'm pretty sure she hasn't seen a tissue viability specialist - I'll check with her tomorrow. Her dressings & stuff are being done by a nurse at the GP's, but I have found out there's a leg ulcer clinic at the county hospital. I'm not sure whether she goes to the hospital for the doppler test, and will double-check that with her as well.

I think the varying dressings are par for the course, as the state of her wound changes. She's really hurting now - says it's hard to elevate the leg as any pressure on it at all, even a cushion under it, increases the pain :( I really appreciate all your pointers; I didn't know where to start looking.

Get down and sit in A&E :(