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 !

I agree with some of your post but not all. Common sense tells me that if antibiotics have been given with a second course of a different one now prevailing, then the condition should not be getting worse. If nothing else, if the pain is now so great that the gentleman can't walk/bear weight some significant pain management needs to be implemented.

@NOTSUREWHATIMDOINHERE get him to A&E now, before the Sunday morning injuries roll in. The team will be fairly fresh at present. In my opinion, that needs to be seen by a doctor.

over the years I have been palmed off too many times by too many nurses spouting shite

That looks necrotic?! I’d be going to A&E straight away

You're certainly not alone in thinking nurses in general practice aren't suitably
trained but, with respect, this assumption is incorrect. I work in primary care and nurses have specialist training in wound care, the GPs don't. So a nurse, or senior nurse practitioner, is exactly the right person for the job.

I frequently have to explain this to annoyed patients who don't understand why they didn't get an appointment with a GP despite the nurse being the best person. They tend to be the same people who also think receptionists are gatekeepers who are making medical decisions when in fact they're just asking the standard questions, the answers to which are then seen by a clinician and assigned to the most suitable person.

Absolutely do not do this 🤯

Glad he’s been seen and being sent to hospital. If there’s a smell I’m shocked the nurse didn’t get it looked at by a GP.

And this is precisely what is wrong with having a GP service by phone. Those pictures you uploaded, @NOTSUREWHATIMDOINHERE - were you ever able to send those to a doctor? The smell should have worried them more - I can only presume they assumed you were exaggerating…

Hope you get seen quickly and appropriate treatment. So hideous knowing something is wrong and no one is taking it seriously. I wish medical professionals would actually listen to what we are saying. Sometimes it feels like if we don't say very specific words that they associate with a condition, the gravity of the situation doesn't register with them. Remember being on the phone to 999 and the horrible distress I felt at not being able to make them understand the terrible urgency of the life/death situation in front of me.

NOTSUREWHATIMDOINHERE posted an update ^

Good he's been seen and being sent to hospital.

He needs to be admitted, I hope they do that today. That needs monitoring.

I had 12 days of outpatient IV antibiotics for cellulitis last year, wasn’t open like that, very red/swollen, ulcers x 2, possibly linked to the swelling. Has anyone mentioned potassium permanganate to soak on? You can get the powder from Amazon, but speak to a dermatologist (I saw one in Ambulatory care when I was being seen for the swelling) or the tissue viability nurse. I’m astonished he hasn’t been referred for that, the GP is entirely the wrong person for this.

I'm glad he is being treated correctly

I was going to say A&E

Relative had something similar in the leg after a serious car crash and need surgical debridement.

After two weeks in hospital and week at home went back to the orthopaedic surgeon for review on the Broken arm who decided to operate to debride the leg wound.

The nurses just kept dressing it

I don't think it looked as bad as the either

Just forwarning!

Thank goodness he’s going to the hospital!

If this were an ulcer on the leg of someone geriatric with lots of comorbidities I could understand the replies of some of the nurses/medics on here.
But context is everything. If this is a non- geriatric in otherwise good health then surely all the alarm bells would be ringing?

A lot of the time necrotic flora (coliforms anaerobes etc) will not be reported by the labs as per protocols from the SMI. The biggest thing is to keep it clean. Ask to be referred to the specialist nurses and ensure dressing changes are frequent. Manuka dressings can also prove quite effective

I didn’t diagnose through the photo . What I said was that the ‘picture’ did not suggest infection / cellulitis.
You need a face to face clinical examination to diagnose severe infection.
I gave safety net advice to go to hospital if he was systemically unwell.

That does look like a fairly standard venous leg ulcer, I see a lot worse on a regular basis. They are painful and unfortunately they quite often smell rather unpleasant.

Is your DH in bandaging ? Sometimes this can slip and cause a bit of a tourniquet effect, which can cause an increase in pain, even if the bandaging isn't compression. Is there any staining to the outside of the bandages or dressings, what colour is it ? are they wet to the touch ? If they are very wet this can also increase the pain and odour.
Has he just been seeing the practice nurse once a week for dressing changes ? It may be he needs to be seen more frequently for a while.

Is he elevating his legs as much as possible, like a PP mentioned ? I am sure people think we are making it up when we say this, but it honestly can make a huge difference to the wound healing process.

Your poor DH, it really is miserable having a wound like this, hope the pain relief he has been prescribed helps.

Just seen your update, glad he has been seen in person and is getting checked out.

We are aware the nhs is crippled, that’s why patients and family members have to go with their gut feeling, not take chances, not feel guilty for putting more strain on the nhs, advocate for themselves.You lost me when mentioned 111 it’s just condescending, because anyone who has experience with 111 knows it’s for non emergencies and it’s a dragged out process.

OP, thank you for the update.

Gangrene is related to arterial insufficiency and this is a young person with a chronic condition - venous insufficiency who has very friable skin and has developed an ulcer. It is not the same thing .
There are millions of people in the community with this sort of problem are managed by nurses in the community who are well trained as it is ‘bread and butter’ is very common work for them.

Yes leg ulcers are distressing and resources are underfunded . The vascular community would love to be able to provide more specialist services.

I would love to hear from OP how her husband has developed such severe venous skin changes. Did he have a major DVT? Is he obese ( this can contribute) . Had he had an ankle injury that affects mobility. Does he do an occupation that involves standing or sitting during the day rather than moving around? Has he had Doppler studies and is he in compression bandaging ?

Absolutely . Practice nurses are hugely experienced in leg ulcers. Far more so than many doctors. Under General Medics in hospital ie not vascular specialists the knee jerk response is ‘must give antibiotics’ when more often good wound care is what is needed.

Wow OP your poor DH that looks so painful.

Happy to hear he’s gone to hospital. How did that even start??

Like you say there are certainly drawbacks to telemedicine and information is lost/not gathered - how someone walks into the consulting room/ how they sit down/ how ill they look/ has the persons general appearance/demeanor/hygeine changed since last seen/their mood /their speech etc etc. All of which can be assessed in the first 5 seconds without asking a single question

The most significant being do they look ill

Hopefully will get better now?
This is so poor. But a sign of the times of how poor our system is. And the fact that so many HCP's just don't seem to care anymore, are blasé and dismissive.

The nurse seen 3 times. It not getting any better. I wonder if she would have behaved differently? When you saw the nurse each time was it documented? Because for out gp surgery appointments, you can request, and attach a photo, so they would be a paper trail, of evidence, of 3 photos, of it getting worse. Did that happen for Dh?

My experience of wound care in the NHS was pretty poor.
After a mountain biking accident they stuck a Primapore on a large and deep skin graze and told me to leave it on for a week!
Its licenced for 48 hours but there was so much exudate coming off I changed it 1-2times a day with ones I bought from Amazon.
Their idea of cleaning was to dab it with a swab. So I lavaged it myself with saline. I guess no one had heard of optimal lavage time to prevent infection….

I'm glad he's getting seen properly. I expected you to say IV antibiotics would be needed too. Fingers crossed for you

No - what you can see from the picture is that this man has very severe chronic ‘venous’ skin changes which will make the skin very friable and prone to wounds which then become ulcers and do not heal. It is part of a chronic problem . It is not that uncommon in younger people .

The question is why it has happened and what can be done to treat the problem ?

In older the problem is often immobility and having the legs down all the time. Obesity and ankle problems contribute. You can have normal veins and develop this picture. It is about fluid not returning effectively from the legs .

Often ‘venous’ disease is not the full picture and the mainstay treatment is lifelong compression, exercise maintaining a healthy weight and elevation of the legs at rest.