Husband leg infection being almost ignored (disgusting pics included)

[NOTSUREWHATIMDOINHERE]

Hello

So been at nurse 3 weeks in row. Had leg infection for 2 weeks antibiotics not working and it's now worse. Smells. Pain so severe he cant walk so will be off work now! Nurse just dressing it and sending him away after asking gp to prescribe 2nd set of different antibiotics after 1st set that was supposed to be the right ones for that infection did absolutely nothing to help him.

What would you do ? We are worried, he can't get about its horrible. He had a venous ulcer but this was due to that part of the leg getting bumped and all of sudden this infection gets worse , he was hiding it from me !

@ThePrologue

I never said anything of the sort, so please don't misquote me.

I never said you had to be obese, to get an ulcer.

A&E, my friend.

I showed the photo of your husband's leg to a paramedic, who said the same thing.

RTFT. He's just been sent home from hospital today.

His bloods being cleared is a good thing, no infection present means his risks have dramatically dropped. I think now you have to advocate for him if he wont do it himself. At the next wound care apt, you need to ask about full compression bandaging, not the stockings, the level of compression from bandaging is much higher. He needs an ABPI assessment, and a doppler possibly - this will determine the level of compression he can be placed in. When i was in the community, though trained to apply compression and complete ABPI's and dopplers, compression was prescribed by tissue viability, so it can take a little bit of time to start the process, but having those assessments is the priority as those were required by TV. There was also often a back log of patients awaiting these assessments, there is a large number of patients living with chronic venous leg ulcers, often housebound, often invisible, my calls would be predominantly redressing in the community, our books were full, but keep advocating for the assessments. In the mean time, keep them clean, with water only, please please dont apply anything suggested on this thread, then gently pat them dry with a clean gauze. The skin that is red not open, you can apply a moisturising cream to, but nothing what so ever on the open ulcers. There are different dressings that can be trialled under compression, one is medial grade honey dressing, which is really good stuff, but this again comes prescribed, not from a local farm shop as suggested by a PP. Keep his legs elevated as much as he can tolerate, try to reduce the time spent standing, or with his feet on the ground when sat down. Healing leg ulcers is a long process, and they can look and smell infected whilst not being. Its an adjustment for everybody involved.

That's good news that his bloods were ok, is he still taking the oral antibiotics ? Its important that he finishes the course. Has he been given stronger pain relief, I'm not sure he should continue on the neurofen if he has been taking a lot over the last couple of weeks, they can cause stomach problems. .
Have the hospital redressed the leg wound ? I would ring and try and get in to see the practice nurse again tomorrow if possible and let her redo it and see if she can allocate some time this week to perform a doppler, if he hasn't had one for over a year ? There are dressings which can reduce the pain, so tell him not to minimise the level of pain to the nurse !
In the meantime regular pain relief and keep that leg elevated, if possible if he can lie on the bed and prop his leg up on pillows, that would really help, and avoid sitting for long periods with the leg down. Boring but does help !
If he starts to feel unwell ring 111 again. And good luck, I know what its like to have a DH who minimises health issues

I’m glad he managed to get seen again and hopefully will have a bit more medical input going forward.

Whilst it’s great that his bloods are clear if he starts becoming seriously fatigued or throwing up while this is ongoing so get him checked asap.

Sepsis doesn’t always come with a high temperature and it moves fast.

I would like to reassure you . In my clinic I see much worse venous leg ulcers that with compression , high elevation and good dressing care will heal. Your husband is young , not diabetic and from the Doppler a few years ago is likely to have normal arteries. These are all factors that suggest with the right wound care the ulcer will heal.
In my 20 years of vascular surgery very few ulcers need surgery or skin grafting .

With normal blood tests this should reassure you that this is not a severe infection . The swab CANNOT tell you that there is infection present although oral antibiotics may help
reduce the burden of colonization. Dressings g with silver or honey do the same thing without upsetting the gut.

I hope that he has an appointment for the community nurses to put him back into compression ASAP ! You would be right to hammer down doors on Monday to achieve this.

🍿

This thread is really bad. People saying he's obese, so ......
So what? I think op said he was overweight. Maybe not even obese. But even if he was. He doesn't deserve proper treatment? From nurse or gp? And now from A&E where he was told to go home? How is that ok?

A&E cant do anything, literally. Im qualified to apply compression, but in A&E im not allowed, we dont even stock the dressing to apply if i wanted to. A&E is for immediate treatments and testings, for admission if something has potential to be life endangering if left untreated. He had bloods, his infection markers were cleared, this is now something that needs assessing, reviewing, and treating in the community. He wasnt fobbed off by A&E, he had what testing they could offer, cleared and directed to the appropriate care setting. The community nurse may have referred for further assessments, she sent a swap and arranged antibiotics, if like in my trust, she is not allowed to initiate compression without a completed assessment and prescribed by TVN, then redressing with standard dressing is all she can do for him at the minute. GP's would refer to wound clinics or wound care nursing, which he is already under by the sounds of it. He hasnt been fobbed off, i think the patient education on the aetiology of leg ulcers is potentially somewhat lacking, but we are hearing this third hand, we dont know what the HCP said to the patient directly, as he has been hiding it from his wife.

Some of the advice on this thread isnt great, ill give you that, but leg ulcers can be shocking when you arent exposed to them regularly, and they can, and often do, look infected when they arent. The comments on weight are also incorrect, i saw many a little old lady/man with chronic wounds who weighed less than one of my arms most likely, yes they can be worsened by weight, and weight is a contributing factor to the likelyhood of developing them, but not all patients with chronic wounds are overweight.

I hope the OP can sift through the posts and share with her husband the ones giving real, useable advice.

@NOTSUREWHATIMDOINHERE - i would highly recommend the legs matter website as a source of information and advice.

legsmatter.org/

They didn't send him away for no reason or because they were prejudiced due to his weight.

It was assessed through blood tests/physical examination that he didn't need to be in hospital, and it's not the best place for many people.

There was no plan of care that required hospitalisation.

At home he can rest, relax, sleep better and choose food that he likes.

Yes he needs ongoing wound care - and will for some time.

There's some good advice here:

Elevation of foot
Contact Community/District nurses team asap (do you have their number?) for redressing/talk about compression
You might need to talk to GP about managing his pain - especially as this is one of the main reasons people don't comply with compression as they can find it painful. Also talk to the GP about time off work - did you say he was self employed? (I might be making that up)
Good nutrition ongoing - wounds need good nutrition to heal well.

I know it's not popular but most of our health management is down to ourselves - I say that knowing I am far far from perfect on that front.

i hope the healing process continues

Thanks everyone, a lot of good advice here. Thanks for the support. Really appreciate it.

He works full time but not self employed.

Will sort his nutrition, started slimming world recently so the weight loss thing is in motion too.

@NOTSUREWHATIMDOINHERE gosh. Is he feeling any better? Is the wound now healing? Less odour? It feels like they were dismissive but if they're saying it's abscess but no infection?
I hope he gets better soon. Can you be firm with the nurse and say 'what you're doing doesn't seem to help. What else can you do?'

Thanks for update. It's a real wake up call for all of us. I'm overweight too, I realise that this puts me at extra risk. I sincerely hope your DH can now get help to heal and recover. Thanks too to everyone here on Mumsnet for your advice and concern. Op, please do post any other concerns you have.

The would itself is really infected, the infection is just not reached the blood stream. They sent him away. Referring Dr wanted him on iv though, but the hospital said no beds and blood clear.

@NOTSUREWHATIMDOINHERE that sounds bad that he needs IV but was turned away. I know there's a wait for beds, but how can they say there are categorically none. I've waited 24 hours but did get one!
Could you go to a different hospital? It feels like he needs more treatment x

@BobbyBiscuits the hospital won't admit him for IV antibiotics if his blood results are fine, because there isn't a clinical need to. If the blood results are fine then the oral antibiotics have probably been working.
Venous leg ulcers like the one OP's DH has, tend to produce a lot of discharge and quite often smell unpleasant, even when no infection is present. This can be managed by applying compression, using different dressings or increasing the frequency of the dressing changes.

I had cellulitis last week and was given IV antibiotics in a corridor in A&E then sent home to come back next day for ortho assessment and then surgical wound washout. They didn’t have a bed, and frankly I didn’t need one because I was systematically well, so the hospital took a pragmatic approach with the resources they had. In your husband’s case, I’m sure if they felt he need IV antibiotics they would have found a way to give him them. The NHS gets bashed a lot, but ultimately they don’t want people dying! I wish you both all the best and hope your husband heals fast.

@Allthemissingsocks that is my understanding too - that iv antibiotics can be given in the community if it's absolutely essential and there's no other way

Ask the PN to refer him to the leg ulcer clinic or vascular service (depending on what's available in your area.)

Strict leg elevation /bed rest will help.

I think you'll find that more up to date research advises that wounds heal better if dressings are left intact for a week as long as they are not soaking through the covering & there are no signs of infection.

www.nursinginpractice.com/clinical/mythbuster-i-need-to-let-the-air-get-to-this-wound/

For those of us who wish to find out more info on leg ulcer & possible infection - here's a link to the NICE guidelines.

www.nice.org.uk/guidance/ng152

They are nurse consultants.
Obviosly they are not medical consultants. But they are intellgent enough, qualified enough, and respected anough by the medical profession to lecture doctors in their speciality

https://www.pcds.org.uk/clinical-guidance/leg-ulcers

Info from uk primary care dermatology society. Includes photos with comments for anyone interested