Home Treatment of Bedsores

Having had the opportunity , frequently , in the last few years to attend , and participate in tne nursing of elderly realtives, one learns that while the medical fraternity in its immense wisdom endeavours to ensure that your folks get the best and correct treatment, it is little things noticed by the those actively partcipating in the patient's daily routine, that actually have a great bearing on the health status of the elderly patient.

He was 88. Very spritely, very active. A very sincere follower of yoga, meditation and various alternative therapies.

But , there came a period in his life , when his energy slowly started ebbing away, like, in miniscule amounts. He, the great and enthusiastic walker, stopped walking. For an active man, mentally and physically, this was a tremendously difficult thing to handle. And as the percentage of time spent lying in bed increased, it became very clear that "bedsores" was going to be the next problem. Mostly compounded by the fact that this patient had a minimum of fat on his body, and was extremely bony.

Bedsores can be as simple as a painful discoloration of the skin, aggravated by friction; or in the worst case , it can be craterlike, with a skin breakdown, which exposes the underlying tissue and bone, along with dead rotting tissue.

What needs to be borne in mind, is that we need to be sensitive to the possibility of infection affecting the bedsore, which then becomes, bad news. Any infection that goes deep, is capable of getting into the bloodstream. Subsequently, it becaomes a case of septicemia, or blood infection; and since blood flows everywhere, its possible that the infection may be difficult to control.

We can do a few things to prevent bedsores :

(a) Change the patients position often.

Prolonged pressure on any part of the body needs to be avoided. Tailbone area, shoulderblades, elbows, and other bony areas given the extra body pressure on these areas, are very susceptible, and prolnged pressure on these areas reduces the blood flow here, to the skin as well as tissues below. So the thing to do, is keep changing the position of the patient in bed. Light powdering of the bedclothes also helps. Air mattresses , water beds, egg crate foam mattress pads, gel pads, sheepskin pads, wheelchair cushions, and alternating air mattresses help in reducing spot pressure, but one still needs to work out a routine for changing the patients position.

(b) Pay special attention to those patients who suffer from urinary incontinence, and/or have to wear adult diapers. Moisture , consistently at one place is the worst enemy of the skin in an old person. Urine is acidic, so it is beneficial to be alert about the status of diapers.

(c) When you change the patients position, lift, rather than drag. Alarming as it may appear to idle folks looking on, the best way is get on to the patients bed, feet astride on each side, and slightly lift and turn the patient through a right angle. Stubborn patients may be kept in the turned position by using a pillow behind them.

(d)Follow a daily routine of examining the skin for discolorations, skin breakages, tenderness of skin, partcularly over bony areas. Keep these areas dry . If you press on the tender area of the skin and observe no whitening of the area as you press, this can be a sign of impending skin breakdown.

(e)If the patient is to be massaged for any reason, avoid massaging over these areas.

(d) A lot of skinny folks develop bedsores on the hip. This can be avoided, by not allowing the person to rest directly on the hip bone as you rest him on his side. Pillows and other padding can be appropriately positioned for the purpose.

(e) If you are using a Fowler's bed, (where you can raise and lower the head portion), be very careful about NOT raising the head by an angle more than thirty degrees. Any higher inclination will cause the patients skin to slide and rub against the bed, which is a no-no.

(f)Knees, ankles, parts of the lower limb that are likley to rub against each other while sleeping may be separated by pillows placed appropriately, without affecting the blood flow to the extremeties.

(g) If you are looking after a patient with diabetes , then be a hundred times more careful and sharp about skin problems. The blood sugar must always be kept in check.

Despite these precautions, sometimes the bedsores win, and then it becomes a case for knowing what is the best possible treatment.

What you need to bear in mind, is, that with an open bedsore, one has to be very very strict about washing of hands, usage of gloves, and not touching anything unsterilised before touching the wound. Washing the wound with Normal saline solution, and Savlon is a good idea.

There is also a solution sold as "Eusol" which is a solution formulated by the Ediburgh University people . Between this and the Normal saline and Savlon, one needs to clean out all the dead tissue that sits rotting in the bedsore.

Wounds that have gone deep and exhibit bone and internal tissue need aggressive treatment.

For the patient that I was looking after, we first used Soframycin Ointment, with dressings thrice a day, and / or whenever we had occasion to change the patient's diaper. Soframycin ended up on the losing side.

We were then recommended a set of bandages called "Sorbalgon" These are impregnated with some organic ointments, that sort of seep into your wound and the entire bandage kind of dissolves inside the wound, offering to the wound, as it were , all its benefits.

A specially prescribed Collagen cream was also used in some of the crevices around the wound and as a sort of top filler. We used a sterilised cotton thickish dressing on this .

Dressings like these twice a day, appeared to be working out well in terms of healing the bedsore, and it was interesting to see how the skin healed, and new layers of differing colors appeared on a daily basis.

One of the home remedies recommended to us, turned out to be widely used by folks across the world, and lots of surgeons. (Those with diabetes/blood sugar problems, need to check thoroughly with a doctor about this).

A mixture of tincture of iodine and sugar, works wonders for bedsores. As this particular patient's bedsores started on a healing track thanks to the latest bandages and stuff, we slowly reduced the Sorbalgon bandages (which were prohibitively expensive), and started on an iodine and sugar ointment.

Honey is often touted to have miraculous healing properties. That too was used.

What seemed to work wonderfully on a sort of preventive-cum-slowing-down-the skin-breakdown basis, is the fact that whenevr we noticed a discoloration building up , or skin patches tending towards developing into a bedsore, we aggressivley used the iodine-sugar ointment. This seemed to work wonders.

In all this world of ointments and solutions, sometimes native food knowledge also plays its part.

Some folks had a doubt. With all the incontinence , diapers, moist environment, and dead skin and similar stuff, wasnt there a danger of ants getting attracted to the sugar ?

Well we had a home grown solution. We bought some clove oil. and a few drops of that were dabbed on top of the final dressing. Cloves are known to keep the ants away from the sugar bowl. No clove oil was allowed to touch the skin or the wound.

This particular patient's bedsores were very serious. With all the recommended treatments, and strict adherence to sterilised implements and bandages, and constant checking and avoiding moistness around the area, the bedsores healed. We continued to constantly turn the patient every two hours.

When a near and dear one passes away due to old age, we would like to think, that there was nothing amiss in our care, and that we did whatever we could to the best of our ability.

While we cannot do too much about things like heart failures, kidney failures , respiratory problems and other symptoms of general organ fatigue and failure, it is a relief to know, that the patient , in his last days, did not suffer septicemia, and succumb to infection in the blood, which need not have reached there, in the first place.