Healing a leg ulcer / venous ulcer
September 20, 2024 7:32 PM Subscribe
My mother is struggling with an ulcer on her ankle which seems to be getting worse. Is there any other treatment she could request, or anything she can do herself to help it heal?
My mother has had a sore place on her ankle for about four years. Nothing was visible until July this year, when it was diagnosed as an ulcer. Since then, she has had it dressed twice a week by a nurse through her GP's surgery. At first the dressings were silver, and occasionally they used steroid cream. Now she thinks the nurses aren't using any creams or special dressings.
Before diagnosis, she was fit and active, running and swimming several times a week, but has now been told not to exercise and to keep her leg elevated as much as possible. She has had a Doppler test and been told that her circulation in both legs is within the normal range, so didn't have to wear an elastic stocking, but that the ulcer would heal faster if she did. She has now been wearing one all the time for a month.
She says the ulcer is increasingly painful, with very frequent sharp stabbing pains, and that it looks terrible when the dressing is removed. It's making it difficult for her to sleep, despite taking painkillers. She misses the running and swimming, and thinks the ulcer is getting worse rather than better. She has gone from being very active three months ago to needing a stick to walk.
Is there other treatment or investigation she should be asking for, or anything she could do herself which might help?
My mother has had a sore place on her ankle for about four years. Nothing was visible until July this year, when it was diagnosed as an ulcer. Since then, she has had it dressed twice a week by a nurse through her GP's surgery. At first the dressings were silver, and occasionally they used steroid cream. Now she thinks the nurses aren't using any creams or special dressings.
Before diagnosis, she was fit and active, running and swimming several times a week, but has now been told not to exercise and to keep her leg elevated as much as possible. She has had a Doppler test and been told that her circulation in both legs is within the normal range, so didn't have to wear an elastic stocking, but that the ulcer would heal faster if she did. She has now been wearing one all the time for a month.
She says the ulcer is increasingly painful, with very frequent sharp stabbing pains, and that it looks terrible when the dressing is removed. It's making it difficult for her to sleep, despite taking painkillers. She misses the running and swimming, and thinks the ulcer is getting worse rather than better. She has gone from being very active three months ago to needing a stick to walk.
Is there other treatment or investigation she should be asking for, or anything she could do herself which might help?
IAARN, IANYRN, TINMA
I see from your profile that you're in the UK, so your phrasing maybe be different than here in the US, so I'm a little confused on the 'GP's surgery'.
There are actual wound care specialists, as well as wound care RNs. Do you know if this is a wound care nurse or if she's a home visit nurse? You can be a home care nurse, know how to handle simple broken skin, but not know how to treat chronic wounds.
Is your mom diabetic? How often is your mom's ankle being attended to - being cleaned, evaluated, dressings changed? Do you know if the wound was ever cultured? Is there an old wound or scar that has broken down (or did the skin just break down)? If your mom has been suffering for three months and is still requiring pain killers, and still has an open wound, I would consider taking her to the hospital to make sure there isn't a deeper infection or something more systemic. They will be able to run bloodwork to see why her body hasn't been able to heal itself properly.
I hope she feels better in short order.
posted by dancinglamb at 2:57 AM on September 21 [1 favorite]
I see from your profile that you're in the UK, so your phrasing maybe be different than here in the US, so I'm a little confused on the 'GP's surgery'.
There are actual wound care specialists, as well as wound care RNs. Do you know if this is a wound care nurse or if she's a home visit nurse? You can be a home care nurse, know how to handle simple broken skin, but not know how to treat chronic wounds.
Is your mom diabetic? How often is your mom's ankle being attended to - being cleaned, evaluated, dressings changed? Do you know if the wound was ever cultured? Is there an old wound or scar that has broken down (or did the skin just break down)? If your mom has been suffering for three months and is still requiring pain killers, and still has an open wound, I would consider taking her to the hospital to make sure there isn't a deeper infection or something more systemic. They will be able to run bloodwork to see why her body hasn't been able to heal itself properly.
I hope she feels better in short order.
posted by dancinglamb at 2:57 AM on September 21 [1 favorite]
Twice a week is not sufficient. My mother had severe open wounds, and she was prescribed by her GP a wound specialist nurse who came to her home daily (mo-sat), changed the dressing and applied medicated ointment, this nurse also took photos to document the developement and show the GP, and checked for possible new wounds. This
Level of Care, covered by austrian health insurance is quite possibly not available or covered by insurance in the UK. But you can always ask i think.
posted by 15L06 at 3:07 AM on September 21 [2 favorites]
Level of Care, covered by austrian health insurance is quite possibly not available or covered by insurance in the UK. But you can always ask i think.
posted by 15L06 at 3:07 AM on September 21 [2 favorites]
PS i just rembered that this wound care Regime was inititally established after a stay in the hospital. Her treating doctor there then wrote the instructions for the GP to prescribe.
I think that after three months and no improvement, i would ask the GP to send her to a hospital, also to make sure the bone is not yet affected.
Pain btw is a good sign - at a worse stage the nerves will be affected eventually leading to no pain.
I am sorry you and your mother are in such a situation. What i learned from going through this with my mother is to be pushy. Very pushy.
posted by 15L06 at 4:12 AM on September 21 [2 favorites]
I think that after three months and no improvement, i would ask the GP to send her to a hospital, also to make sure the bone is not yet affected.
Pain btw is a good sign - at a worse stage the nerves will be affected eventually leading to no pain.
I am sorry you and your mother are in such a situation. What i learned from going through this with my mother is to be pushy. Very pushy.
posted by 15L06 at 4:12 AM on September 21 [2 favorites]
Response by poster: Thank you all. She isn't diabetic. There wasn't a previous injury, just the skin breaking down, I think. She has had an x-ray. She thinks they may have done a swab, but isn't sure. The nurse isn't a specialist. She will check about the swab, and ask about referral to a specialist service.
posted by paduasoy at 4:57 AM on September 21 [1 favorite]
posted by paduasoy at 4:57 AM on September 21 [1 favorite]
If this is a venous leg ulcer, you might find this NHS rightcare material helpful as it describes a sub-optimal and optimal treatment path for ‘Betty’.
posted by plonkee at 5:01 AM on September 21
posted by plonkee at 5:01 AM on September 21
My approach would be to coat the wound in liberal amounts of ointment e.g. vaseline / petroleium jelly, or even something medicated, but always oil based and always very liberally applied, then loosely wrap it, changing this dressing twice a day to start and then once a day as it settles down to heal. Open sores should be kept away from the air so they don't dry out, this is critical.
posted by seanmpuckett at 5:46 AM on September 21
posted by seanmpuckett at 5:46 AM on September 21
Honestly, if there is a change in a wound where it looks worse and it's causing an increase in pain go to an emergency room, and get new cultures. There are all kinds of nasty bateria that can take up residence in a even well cared for wound, so a new immediate evaluation can get a better clinical picture. If there is a need for a change in wound care , antibiotics or other changes it can be done from the hospital and set up prior to discharge.
Don't delay with a wound that is causing increasing pain and decreased mobility.
posted by AlexiaSky at 6:24 AM on September 21 [7 favorites]
Don't delay with a wound that is causing increasing pain and decreased mobility.
posted by AlexiaSky at 6:24 AM on September 21 [7 favorites]
Response by poster: That's fascinating, plonkee, and I know my mother will find it so too. Thanks.
posted by paduasoy at 1:00 AM on September 22
posted by paduasoy at 1:00 AM on September 22
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Also, are you sure "ulcer" is the right diagnosis - has she had a cell biopsy of the wound (could be some kind of skin cancer)? Or a bacterial swab? Maybe time for a visit to a different doctor.
posted by nouvelle-personne at 8:13 PM on September 20 [7 favorites]