I am the owner of a large, and ever-growing, leg ulcer, and the problem is finding a dressing that will absorb the increasing exudate and bleeding, that is bactericidal (I don’t want a repeat of last year’s infection marathon and I most definitely want to stay out of hospital), and does not gratuitously cause me more pain. Apologies for the pic if you’re squeamish, but I find it helps people who haven’t fallen victim to this most foul affliction understand the problem. Two months ago that was two tiny, almost painless, lesions, each the size of a 5p coin. Why it’s now one big one no-one is able to tell me. I’m told it’s a venous ulcer and, indeed, it looks like one. However, it also has the characteristics of an arterial ulcer (pain when my leg is elevated, relief when sitting). So, can an ulcer be both venous and arterial at the same time? Based on my experience, it would seem to. More research needed.
The other reason for posting it is because the nurses want to check the blood pressure in my leg, and the only place they can do this, apparently, is – yep, you guessed – right where the ulcer is. A dressing can cause extreme pain, so trust me when I say that a blood pressure cuff will not be allowed anywhere near that! The Tissue Viability Nurse sent me a message to say that it only takes 10 seconds, so would I consider it? Given that I’ve had this done several times already, I know that for the flat-out lie that it is so, no, I will not. And why, ffs, do medical staff so routinely lie to patients? Do they think we’re all idiots? That they won’t be challenged when they spout such obvious bollocks? Medicine, including surgery, is based upon the informed consent of the patient. In law that consent is abrogated if it’s based on a lie, and any resulting procedure should be treated as an assault.
Mepilex Ag dressings (Ag is the chemical symbol for the silver content), meet most of my criteria except one – in use they are hugely painful (and yes, I know what the website says!).
For reasons which entirely elude me, the silver-impregnated pad which is in contact with the raw flesh of the ulcer is adhesive! This, as you might imagine, can be staggeringly painful as the slightest movement causes it to drag at the exposed and suppurating flesh. And one of the major, pain-causing, features of leg ulcers is that nerve-endings are exposed, and even the draught from an open door, or an electric fan, can cause excruciating pain, so applying about 10 square inches of sticky goo really does not help at all!
But I have a fix for that.
I need the absorbency of the Mepilex to cope with the exudate – I do not need the pain it causes and, this morning, I had a flash of inspiration – why not cover the sticky pad with a single layer of sterile gauze? The silver should have no difficulty penetrating the open structure of the gauze, as long as normal aseptic procedures are followed there should be no risk to me, and it will stop the buggerdly thing sticking where it shouldn’t.
It’s a little over two hours since I changed my dressing – and dressing changes always result in extreme pain – but today things are much better. Yes, I still hurt, and by normal standards probably quite a lot**, but it hasn’t sent me scurrying to top up my Oramorph with an extra 5ml as it usually does so I’ll take that as a win.
**If you’ve ever had a dentist drill into a nerve then you’ll have some idea of how painful a leg ulcer can be – but the ulcer is worse because it won’t stop – the dentist does.
So far, then, so good – I think what I have here is a valid breakthrough. Crunch time will be tomorrow, when I change the dressing.
The absorbency of the Mepilex won’t be affected at all, the only question is whether the gauze will come away cleanly or will weld itself to the wound and, if it does, how painful will it be to remove?
Check back tomorrow for the gory details!
NB: As I said, it’s a couple of hours, now, since the dressing change, and while I have more pain now than I did initially, it’s still below its normal horrendous level. As regular readers might have spotted, I had my morphine increased by almost 30% a week ago and the pain then was so extreme, using Mepilex, that even the increased dose couldn’t cope. It can now.
I mean, I’m not deluding myself about the pain, nor do I want to mislead you – I have 90mg of Zomorph, a somewhat generous 10ml (OK, 15), of Oramorph, and 1g of Paracetamol in my system. Without those, things would be very different.