This, below left, is my ulcer now. (It’s gross – don’t want to see? Don’t click through.)
It’s evident, and should have been so last week, that given how much effort we’ve put into trying to dry this thing out, using a dressing that was 60% water bordered on the criminally stupid. The only reason I accepted it was out of desperation – because nothing was working. I was told that the dressing would remove slough**/necrotic tissue, yet there is nothing in the literature to support this view, and no mechanism by which it can happen. The trial (below), mentions a reduction in slough – it makes no reference whatsoever to the means by which this is achieved (I might possibly have missed it – the pain makes it difficult to concentrate, but I don’t think so).
**Slough is the yellowish gunk. The black is oxidised silver from the Aquacel Ag dressings.
In my view the Hydrosorb dressing created a perfect, moist, environment for the ulcer to spread into the water-softened tissue.
The Hydrosorb trial I referred to in my previous post says this about slough:-
They were treated with Hydrogel comfort for an average of twelve days and the dressing was changed every 4 days. The wound status improved markedly in the course of the study. The proportion of the wound surface that was covered with slough fell from 62.7% to 23.1%.
There is no suggestion that Hydrosorb actively removed slough, which I was told it would. There is, apparently, nothing in the gel but water (and the gelling agent, of course), so how does it achieve its claimed results? And of the meagre test population of 81 warm bodies (I think I originally said 85), some had just Hydrosorb, some had other products added, and some were in compression so, all things considered, it’s my opinion that it’s quite impossible to draw any useful conclusions in respect of Hydrosorb from any of this at all. Find the trial report in this document http://www.hartmann.co.uk/images/w-forum_oct_08.pdf page 6. One claim that I find utterly unfounded is that Hydrosorb provides cushioning for the wound. It does not, it’s just too thin.
When I removed the Hydrosorb – and, granted, it had been in place for only 24 hours, but the pain was unbearable so it had to go – there was no sign that it had absorbed anything. It was still crystal clear.
We had the usual it’s compression or nothing argument at today’s dressing change. I’ve tried compression 3 times, and three times it’s gone bad on me. The one time I had it done in the hospital, at the vascular clinic, they blithely wrapped up an infection – something that is totally against the rules. So, not unreasonably, I am not interested in there being a fourth time.
One nurse bitchily announced that all this was my fault, as I shouldn’t have refused compression when the ulcer was tiny. Which is the purest bovine ordure.
See the pic below? While one of the staff nurses was peering closely at that (I’d taken the pic just minutes earlier), she spat into the open lesion. OK, it was an accident, which is why I didn’t make a formal complaint (though with today’s nurse trying to re-write history I wish I had). She was talking to me while peering at it, and accidentally sprayed it with saliva. And it’s from that event that I date the serious deterioration that brought me to where I am today – something everybody is going to be reminded of at the next dressing change on Friday.
Anyway, I said, as I always do, that I will accept no treatment that is going to inflict even more pain on me, so if they want me in compression what were they going to do about that? No reply. It’s a question I’ve asked many times in the past, and the answer as always been “There’s nothing we can do,”.
I didn’t believe it then and I don’t believe it now, simply because nobody in their right mind, having experienced the pain of a large ulcer (mine is now a centimetre wider than it was on Monday), and the pain of compression, would willingly combine the two. Not unless they had a death wish, and I don’t.
Then I found this nugget in the above trial report, about the patients who opted for compression:-
To treat the chronic venous insufficiency, compression therapy was prescribed for 24 patients. In 22 patients, measures to relieve the pressure on the wound were employed…
So only 2 patients thought compression was acceptable without some form of pain control. What form it took (other than pressure relief), and how successful this was, isn’t mentioned. My guess would be not very given the extremity of the pain I’ve been experiencing. It would take more than pressure relief – even the breeze from my electric fan causes severe pain when the ulcer is exposed during a dressing change. In fact, gut-wrenching pain can kick in for no reason at all, at any time.
And, of course, I’ve already been told that I can’t have compression until my leg’s been Dopplered to assess the quality of the circulation (given that both hands and feet are plagued by cramp, I’m guessing it sucks), but part of the test involves the use of a blood-pressure cuff and, I’m told, there is only one suitable site – right where the ulcer is. So, then, I can’t bear the slightest breeze on the ulcer, but they want to crush it with a BP cuff? Never going to happen. And you can take that to the bank.
And on that note it’s gone midnight and I’m off to bed.