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Veronica 91.

I didn't say I was nurse for 30 years. I didn't say how long I was a nurse because in my book being anything for a longer time than anyone else does not give one greater authority or knowledge,

There's no need to 'trump' anyone or do a triumph dance for all to see. If you want to be the chief, then go ahead and flap your feathers. I am, not in a competition with you or anyone else. I am, here to share what I know and hope it is of benefit to some. If it is not beneficial to you, because of your greater knowledge, then so be it. But I do wonder why you feel the need to be the top dog all the time. How does the heklp anyone except yourself?

This is not a game. For those with pressure sores it is deadly serious and can be the difference between life and death.

I trust that we can all remember that.

Farewell.
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Try Noni Juice. We found that it is extremely effective.
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I am so sorry about your father's situation. I am probably not much help, but my mother developed a nasty pressure ulcer back in February while in the nursing home. It was infected at first, but later controlled by antibiotics and wound care doctor visits that the nursing home took her to. She was more wheelchair bound than bed bound for the last five years. Unfortunately, it was a stage 4 and caused osteomyelitis. The wound care nurse kept it well covered and treated with a wound vac. I was so confused by all this and did all I could to help and miss her soooo much. She DIED last month with complications of this, diabetes, and failure to thrive with much weight loss, including a loss in mental status going many years back. She was 73. I also contacted the dept of health administration to make my complaints after giving it to the nursing home. Good luck, and a prayer for your father.
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bag balm
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My mom had this problem - she is in a nursing facility and it seemed to take forever for the sore to resolve using something they fancied called silver nitrate, which was not very helpful at all. I found this wonderful fanny cream called Dermacloud and had awesome results!! I got it from a Medical Supply store for about $37. Along with the turning every 2 hours, it was really good. In addition, there is something called medi honey (not quite sure if this is the correct spelling) that also helped.
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Make sure the patient is eating well and has enough diet protein. Skin needs nutrients to heal. My father had a stage 3 bedsore under NH watch but then they healed it in less than 3 mos. I was impressed. But I put extra protein powder in his diet because he was not eating well.
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As MaggieMarshall said here, Lantiseptic is a wonderful product for bedsores. The attendants have been using it on mom for over a year now; it has to be applied LIBERALLY and EVERY TIME A PERSON"S SOILED UNDERCLOTHES ARE CHANGED, but it works wonders.

Unfortunately, bedsores for someone who is stuck in a wheelchair, doesn't ambulate and goes from wheelchair to bed and back again are a part of life. They require constant, vigilant care. We persisted and persisted and persisted and persisted, even to the point of calling the corporate headquarters of the NH to get this attention to mom and it's true: the wheel that squeaks gets the oil.

Also: hard but true: patients who get regular visitors are going to get more care. For awhile I would pop in at different times of the day so no one could say for certain if or when I would be there; miraculously mom's care improved.
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It doesn't matter nearly as much what you put on it as what you take off it and that would be PRESSURE. Remove the pressure from it.........get him a plexis mattress it's air mattress that changes pressure constantly also turn him every 2 hours right to left side only not on his back when up in chair have him on a jell cushion and play musical chairs meaning get him up walk and change chairs he's sitting in every 2 hours
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How can you tell the stage? I am not the asker but similar situation. Nurse says thinks stgae 2?
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I would immediately seek medical attention beyond what the rehab facility is doing. The stage of the bedsore needs to be identified and simply turning your dad may not be enough. The problem with the hole in the Depends solution is that if urine exits his skin may still be in contact. It may pool around the sore as the surface it exits too may not draw it away from the skin--as depends is intended to do. Changing it frequently is better than cutting a hole. As an attorney I have seen many sores worsen simply because patients assumed the nursing facility was taking proper care--but depending on the facility they may not have the proper measures or equipment in place or are simply neglectful. You are lucky to know about the wound--believe it or not often facilities don't alert family. I can go on and on about the cases I've seen where sores got worse without the proper medical attention. I don't know enough about the care being received but don't delay. In short, get the stage of sore identified and PROPERLY cared for by a bedsore MEDICAL EXPERT. Call in your own. Here's some Treatment info and a FACT SHEET I hope can be helpful. media.wix/ugd/267f0e_7982e18466294f9fb87b5229b0596254.pdf
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I forgot to mention that you do not eat the honey, put a teaspoon of the honey directly onto the bedsore or skin tear...
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//smile.amazon/Flora-Manuka-Honey-8-75-honey/dp/B004P8FYOU/ref=sr_1_2?s=hpc&ie=UTF8&qid=1410959313&sr=1-2&keywords=manuka+honey

We had a resident come in with a stage II bedsore and was told to try this natural remedy - Manuka Honey. It not only cleared up the bedsore, but works on skin tears too!
Good Luck! Kathy
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LOVE, not War!
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Veronica,
Thank you. It is a hard journey. I appreciate the sharing of knowledge,tips, anecdotes etc.
I'm sorry for your bad memories. I am blessed to have never been exposed to war in my own back yard.
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Doodlebug your name is forgive,. it just brought back bad memories for me.
You don't need to apologise for taking umbrage at Ronnie. He hit a nerve with me too as you may have guessed!
You are quite right at the end of life being or shall I say eating 'healthy" is of no consequence. nor really is anything else as long as it does not impact the quality of the patients final days.
This forum is about supporting each other not critisizing or making them feel bad or guilty when they have done something others consider to be "wrong".Pointing out a better or alternative way is far kinder. I don't think anyone comes here who is deliberately treating their charge cruelly or neglectfully. They don't need us they know plenty of bad things. No, everyone is trying to do their best with the rescources and knowledge they currently have available. Your best is always good enough that is why people ask questions to see if someone else knows of a better or different way. Sometimes there is not anything else you can do and that is alright too as long as you have used all the help there is out there. AIl you can do at times is accept the inevitable. You have learned a great deal and will continue to learn as you continue on this journey.
By the way I don't think Pam was scolding you. I read her post as somewhat tongue in cheek. As you have gathered Pam is a woman of few words but each one does count. I have never disagreed with anything she has posted (I wouldn't dare) so all is forgiven not that there was ever anything to forgive. Blessings
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Veronica91, I did not "choose" the name, it was given to me many many years ago by my sisters....it has nothing to do with the moniker you are referring to. When I was about six years old I was "helping" a tumblebug or as we called them doodlebugs, move it's pile of doodle. Hence the name "Doodlebug". Also I tend to "doodle" as in draw or doodle as in try a lot of different things.....:-).

I did post the positive things we did for mom, those seem to be overshadowed by my taking umbrage to Ronnie, again I apologize.

I concocted a smoothie that my mom enjoyed that helped with her healing. It was between 1500 and 2000 calories and she could sip on it as she felt like it.
High protein drink, a scoop of ice cream, a container of yogurt, a cup do half and half, a scoop of the Decubamine, and sometimes a candy bar. Puréed together in the magic bullet. Maybe not " healthy" but she loved it and often other than breakfast it was all the nourishment she would take. Towards the end of life sometimes the rules must be thrown out the window. I cherish everyday she was here and it was truly a blessing to be with her.
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Try using an egg crate foam under sheet to relieve the pressure.
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Sorry Pam I refuse to play nice.
I can trump Ronnie's 30 years of nursing with another 20.
I do agree there are lazy and incompetent nurses all over the place and the issue of a patient getting bedsore through criminal neglect is absolutely right. Vstefens is a physician as well as being a caregiver and in this case as always i respect her postings. One thing she did not mention was that the real cause of a bedsore is a lack of adequate blood flow to the area. In the majority of cases this is caused by inadequate relief of pressure to the area.
Towards the end of life the blood flow slows down and all the turning in the world will not prevent some sores on a skelital patient. The poor old heart is just too tired. So I do not want anyone to feel guilty when they have done their best and followed all the appropriate instructions if their loved ones do get sores. Some people just are not able to let go and pass over and their bodies seem to start the decompasition process before they actually die. Horrible as that sounds it is not the fault of the caregiver. I have even seen a sore on a patients nose in addition to others all over his body.
So Ronnie get off your high horse please I am sure you were an excellent nurse and an exemplary caregiver.
Doodlebug calm down you are doing all the right things and getting into this kind of argument is not helping the original poster who was looking for help with her current predicament not the history of maggots. Shall we move on to leeches too I hear they are making a comeback.
Doodlebug why did you choose that name? Do you know what a doodlebug was? It was an unmaned flying bomb that the Germans sent over England in WW11 in massive numbers. You could see them coming and as long as you still heard the engine you were ok but if it cut out you only had seconds to find shelter. Just as frightening as the shelling in the Middle East must be.
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To pamstegman,
Yes ma'am. I got too ruffled. We took great care of our mom. I took offense at being chastised by someone who doesn't know me nor anything about the care we gave. This is a great forum and we are here to help one another not criticize. I am now caring for my MIL and learned a lot from caring for my mom. I was not aware if this site eight years ago when mom was still alive, it would have been a huge blessing to hear what others are doing/going through.
I read this site everyday now and have for the past two years. It has helped me in a lot of ways. I apologize to the community here for being rude.
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Mom had spent about a month in the hospital. When she came home, she had this bedsore on her right buttock. Prior to this, I thought bedsores were these pimple-like rashes. When she came home, it was a sore with a hole. Quite gross. And I was expected to clean it. Uhm.... I don't think so. Instead, when I changed her pamper, I changed the dressing. When the home care nurse came, I asked her about it because the hole was sinking in deeper. She cleaned the wound and said she will bring some Duoderm. We spent several weeks using this. One sheet cost $10.00. We spent over $100.00 on it. Every 3 or 4 days, I would peel it off (per the nurse) and change it with a new one. I can see that the hole was slowly healing back up.

Then this year, my bedridden dad got his bedsore. I saw it start as an abrasion. To a washed out color skin. To a pimple. Then it had a hole. I kind of panic when I would change the gauze dressing and his blood would literally drip down. Mom's bedsore didn't bleed like that. Hers oozed with yucky gooey stuff. Dad's was the blood dripping down. I mentioned to the home care nurse about it. When she was in the states, she specialized in wound care. So, she showed me how to clean the hole with gauze and qtips. Then how to stuff dad's hole with the gauze. Then she covered it with the gauze.

She explained that it's very important that dad stay off the sore, change position.
She said that the wound must be cleaned and kept dry (hence the gauze inside the hole.
She said that it's very important he takes in protein (helps his body heal faster), etc... I can't believe with her ministrations (without using Duoderm), the hole started healing back to normal. FYI, I just could not stuff a gauze inside the hole. Made my stomach queasy.

With mom, the air mattress worked well. My dad hates his. So it's off. What I've done was buy these chair pads and insert it beneath his butt. It has helped a lot with preventing bedsores since my dad refuses to turn positions 24/7. He is 99% always on his back - day and night.
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Let's play nice kids. Doodle and Ronnie, gloves off, OK? We can all disagree without being disagreeable. Some people like MOM some like maggots and some let the dog lick their wounds. Whatever works.
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Perhaps you did not read my earlier post where I mentioned trying to get those special beds.....we had no luck getting one that worked properly. We were told that our mother would be getting the same type of bed she had in the hospital that was run on air and constantly moved but that is not what we got and the ones that were delivered never worked properly. I take offense at your lecturing me. You may indeed have taken care of hundreds of patients but you were not here when things were happening to my mother, we did the very best we could for her and no thanks to the medical profession who gave up on her. My sister and I took care if her 24/7. Hospice came in to my home to oversee her final days and they were very surprised at the level if care we were giving her. Too bad you are not here for everyone, my apologies ahead of time but you sound rather pompous.
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The surgeon is out of order. He is wrong.

To save a patient's life, turning much more frequently is not only necessary, but to fail to do that is negligence amounting to criminal negligence, since the failure to do it can lead to a patient dying!

Surgeons and their hospitals charge enough to be able to afford a higher staffing level and so they should provide adequate coverage.

BTW - you are not correct when you say "We all know what causes bedsores."
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There are a lot of people that do not know that. Do not stifle the spreading of valuable and life-saving information.

I cannot conceive of anyone defending this kind of inefficient and uncaring nursing attention. Special beds and mattresses and pads are readily available to prevent the very consequences you accept as inevitable.

Perhaps you have given in too easily. That is a mistake for which our loved ones will pay.

But mine will not because if I have to I will do it myself, as I have done for literally hundreds of post-stroke and paralysed patients during my years as a nurse.

I have seen lazy careless doctors and nurses and not allowed them to continue their sloppy careless ways to the detriment of patients.

Caring for the sick is a sacred duty that demands our very best at all times.

You can have a wound care nurse visit your patients at home if transporting them would cause more damage. There is a way to treat patients, and then there are better ways, but finally there are the BEST ways, and that is what we have to put in place in spite of all the naysayers and 'I-know-betters' in the world.

Give them the very best, and do not be satisfied with anything less.

I wish you well.
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Ok, we all know what causes bed sores/ pressure sores, but as the surgeon who treated my mother said " it is impossible to turn a patient very two hours 24/7". Not only can the care giver(s) not keep up the schedule, the patient can not tolerate it either." My mothers sores started in the nursing home. When my sister and I defied our step-father and brought her home the process had already begun. We were able to heal one of them but the ones on her poor little hip bones were too far gone. Even surgery that cleaned out and cut her to the bone did nothing to "cure" her. Weekly trips to the wound care center only caused her more pain and accomplished nothing in the long run except for the hospital and clinic getting money from insurance and Medicare.
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I have read the cures above. However, it is essential that you understand that no cure is possible of the cause of the pressure sores is not addressed and eliminated.

Prevention is better and easier than a cure, but no amount of curative therapy will work if the underlying cause is not removed and removed PDQ!

The cause of pressure sores is ischaemia. This condition exists when a patient has insufficient muscle or fat tissue over a bony protuberance where that protuberance rests on the bed, chair, or other surface.

The weight of the patient's body or limb compresses the flesh over the place where it rests and squeezes the blood vessels that feed and nourish that part of the body, so the devoid of nutrient the tissue dies, much as does heart muscle in a heart attack, which is an ischaemic episode in the heart, resulting in death of some of the heart's muscle tissue.

If the ischaemia is not immediately relieved, the condition will persist abnd could result in gangrene of such an extent that the patient will die.

All maggots do is eat dead tissues and also, one hiopes, take away any germs that have lodged in the would. But maggots will not cure the sores because they do not address the aetiology of the condition.

So, the first objective is to remove the causative factors. Then, seek restoration by whatever keeps the wound dry, infection free, and maximises the restoration of healthy tissue so that recovery takes place.

Open wounds on which patients are bearing weight and on which they continue to bear weight are extremely painful. Therefore, sufficient analgaesics must be administered regularly.

The appearance of pressure sores in bedridden or chair bound patients is ALWAYS a sign of criminal neglect.

Someone has to take notice, remove causes, apply proper remedies, including fail-safes, and restorative therapies. No delay is permissible or forgivable.

Twenty-minutes, thirty-minutes at the most, is long enough for an at-risk patient to be in an at-risk position.
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Your father needs to be under the care of a specialist wound nurse. Ensure that he is seen.

Discuss this with the visiting physician, your Dad's PCP, the chief nurse, the nurse director, and the chief administrator. Never take 'NO' for an answer.

Two hours is two long for a patient at risk to be in one position without a ripple mattress.

In each of these discussions you do most of the talking and mention 'lawsuit' often and loudly.
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Pressure sores mostly need pressure relived as full time as possible. Whether you put honey or Mepilex on them, they need blood flow to heal - more than you would need just to prevent one. You must also have good vitamin and protein status to rebuild tissue. Common mistakes in pressure relief include being in positions that put pressure on the sore - e.g. lying flat on back with head of bed up and the sore is over the sacrum or over the tailbone, or sitting AT ALL if the sore is on the ischium, or too tight of a packing or padding that does not actually allow for good blood flow. If a person cannot help but lie on a sore part of the time, a low air flow bed like a Clinitron is one of the few ways to get away with that. A prone cart is one way to mobilize a person who cannot sit, a lot of places may not have one though.

Some other factors are how deep is the sore and is it good and pink or does it have yellow, black, brown, or grey "slough"? Debridement with special dressings, whirlpool, enzymatic, or by hand by the doctor or APN might be needed. Do the edges undermine? - if so, surgery may be needed, but maybe a Wound Vac could still work.
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I've also just read about maggots as a treatment method and they're pretty danged successful. They're just doing what nature intended for them to do. I'd investigate it, if my loved one had a non-healing bedsore/pressure sore.
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Bedsores, pressure sores or decubiis ulcers are all the same very nasty condition and extremely difficult to treat. All I have to offer extra is the "Duoderm patch which is placed over the ulcer and left in place for 5-7 days then replaced as needed. they are very expensive but he temptation to change too frequently is very great because as the debride the wound there may be nasty leakage and often a futher dressing has to be applied over the top.
As with everything else prevention is the best cure. If the patient is not incontinent as Pam suggested lying on real sheepskin not some nylon fake does a lot of good.
Unfortunately it can't be washed. I don't understand why because sheep don't shrink in the rain!!!!!!!
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Bedsores are ugly, stink, and get very deep! Make sure the person is turned every 1 to 2 hours, keep the area dry and clean, after debri the doctor might suggest putting a "vacuum" to continuously keep it clean and free of dead skin, etc.
My Mom just passed away from the deterioration to her back side. The Doctor made me look at the opening and it was not a pleasant sight to see all the way though to her pelvic bone, etc. He suggested a feeding tube, a tube for eliminating bowel excrement, a catheter, and many other keep her alive type equipment.
I told him NO for that is not the quality of life she would want to be hooked up to machines - she just wants the "little white pill" to prevent her from pain and suffering to join her beloved husband.
She rallied her last day with Hospice informing me this was not the proper setting for Mom because she was sitting up, talking, eating her pureed food. As night came she told them she was very tired and wanted to go to sleep, they asked if she was in pain and she retorted "My butt hurts!." So they gave her a pain reliever and nightly sedative to ease her into sleep-the "little white pill".
When they checked on her at midnight they found she had peacefully passed over in her sleep. They listed her death as dementia, not the complications of diabetes, bedsore, or loss of will to live. But she is now with her beloved husband and other family and friends that went before her to make her passing easy and special. Mom and Dad are now dancing together to the oldies/swing era music they both so love. Thanks for the great, stable, positive, and fun, upbringing you gave to us. Love You Mom and Dad.
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