As in I’m positive it really is healing.
We use 5cm square Aquacel Ag silver-impregnated dressings. Some 3 weeks ago we were having to use 2 of them to get full coverage, now just one is more than enough.
I appreciate that, to most of you, it still looks pretty horrible but, trust me, what you’re seeing is a considerable improvement. If you look carefully, you can see, surrounding the circular ulcer, the rectangular imprint of the dressing pad. I’ve drawn – badly – a short line to show one edge more clearly. You’ll have to pretend it’s a straight line!
Anyway, the imprint of the dressing is 5cm on a side and you can clearly see how much smaller the ulcer is than the imprint. And that is a positive result.
I now have enough dressings to do what I’ve wanted to do for a couple of months – change the damn things daily. What’s been stopping me is getting supplies. One nurse would bring me a couple, and the next one would come with no supplies of her own, and use my stock! So I had a moan about that and, today, got a handful of Aquacel Ag and, more importantly, a bunch of the hydrocolloid caps that seal the dressing to my leg and contain any leakage – and it’s these that have been hardest to come by. See** below.
As of now, I have 11 of those, and if I can stop nurses nicking them that’s enough for me to prove my theory – that a daily dressing change is the road to healing.
Or disprove it, of course, but based on what I’m seeing and feeling I’m quietly confident.
And the nurses have referred me, again, to the vascular surgeon I should have seen last year, before I was transferred to the clown that compressed an infected leg. The problem is that the guy disappears every summer to work in Africa so it’ll be a long wait. I asked them to make it clear to him that compression was off the table, so we don’t waste time on something that isn’t going to happen.
I also found out, from today’s nurse, who’s finally accepted that I’m serious about refusing compression (though why there should still be any doubt about that I have no idea!), that there are patients for whom it’s unsuitable, and there are alternative treatments. The next step is finding out what they are before my appointment (which won’t be before the autumn), so I can negotiate treatment from a position of informed strength, not flounder in ignorance.
I firmly believe that with the right information the doctor-patient relationship should be an equal partnership and that treatment should be agreed (as it now is with the nurses), and not imposed, though I have yet to meet a doctor who feels the same way. Doctor knows best is still very popular – with doctors.
**They are supposed to be left in place until they fill up! All that does for me is increase the risk of infection, cause the skin, which is kept constantly wet, to break down (maceration), and generally impair healing, while causing a lot of pain. This pic shows one that’s full to bursting point, in the space of 2 days (some have a dotted line marking the limits, this type turns white).
Changing daily prevents this, the dressing is just damp enough not to stick to the wound, not soaked, and the ulcer clean and improving.