Life on Wheels (21 page)

Pressure sores can be serious enough to kill, if not cared for properly. Large sores become infected more easily, with so much tissue exposed, often at deep levels below the skin. Small sores ignored will inevitably become large if left untreated. There are three stages of pressure-sore development:

Stage One: Redness of the skin. This stage might last for a short time, as circulation is restored to the area. The longer it lasts, the higher the risk of skin breakdown and the greater the need for caution. The area will be warm to the touch if it is approaching skin breakdown.

Stage Two: An open area or blister appears. The skin might darken to a blackish color. This indicates cell death, at which point an open sore is inevitable. Remove all contact from the area to minimize any further cell death and to prevent the resulting sore from becoming any deeper.

Stage Three: Open wound into deeper layers of the skin. Risk of infection is very high, particularly for sores close to the anal opening, where there is a great deal of infectious bacteria.

At its worst, a severe sore can progress into tendon, muscle, and even bone tissues. Such sores are likely to require surgery, either to stitch them closed (not always possible) or to perform a “flap,” in which a thin layer of skin is taken from another part of the body and grafted onto the sore. A long nursing facility stay will be necessary to allow the skin to integrate itself into the new location and for the wound where the flap was taken to heal. Flaps do not always take, so all this time can be spent for naught. The need to limit your activity and stay in bed can produce additional sores in the process, trapping you in a downward spiral of skin breakdown. Be very serious about pressure sores. They are not worth the risk of these horrible possibilities.

Keep the sore clean so it can heal. Dead tissue or bacteria will slow the healing process and increase the chance of infection. Dead tissue and dried blood must be removed for healing to proceed effectively. You may be able to remove this yourself—for example, with wet-to-dry dressings. This process should not be painful. If it is, see your doctor. A doctor might need to remove the tissue with a process called debridement.

The sore should be cleaned every time bandages are changed. Your doctor might recommend a cleaning solution, such as saline solution, to irrigate the sore. Saline solution can be purchased at the drugstore, or you can make it yourself by dissolving eight teaspoons of table salt in one gallon of distilled water. Make sure that the salt is completely dissolved and that you use clean utensils for measuring and stirring. Antiseptics such as hydrogen peroxide or iodine—although known for killing bacteria—are not recommended, as they can damage sensitive tissue. It is also important to keep the skin moist. Sufficient cell hydration is crucial to the healing process.

Your doctor might recommend any of several measures to help the sore heal:

Wet-to-dry dressings. Dead tissue adheres to this special dressing as it dries and comes off when the bandage is removed.

Hydrocolloid dressings. These dressings retain oxygen and moisture. Sometimes they are left on for days at a time.

Enzyme medications. These medications dissolve only dead tissues.

Gauze. Often gauze is soaked with saline solution. It must be kept moist, or it could pull off new tissue when it is removed.

Hydroactive dressings. Dressings such as DuoDerm

are left on for days and allow the body’s own enzymes to dissolve dead tissue.

Electrotherapy. Application of a very small current to the tissue to stimulate healing.

When there is infection present, dressings must be changed often, so hydrocolloid and hydroactive dressings are not used. Infection can spread to tissues or bone, so do not delay reporting any redness or swelling to your physician.

Diet plays a very important role in the healing of a pressure sore. The body is trying to rebuild a part of itself and needs proteins and nutrients as building materials.

When a sore occurs, a great deal of protein can be lost from the sore itself, depending on its size. Protein should be included in a healing diet. Good-quality protein for healing comes from eating whole grains—brown rice, quinoa, bulgar wheat, and rye—and beans—lentils, peas, chickpeas, kidney, pinto, and lima. Vegetable and grain proteins are more effectively metabolized by the body than is meat, and don’t include other elements that place a load on the body, such as fats or remnants of drugs used to fatten livestock. Use animal foods judiciously rather than relying on them as a primary protein source. Processed sugar—hidden in most commercially produced foods—uses up other nutrients when it is digested, robbing the areas that need them. White, processed flour has a similar effect.

Stress also disrupts the process of healing, causing nutrients to be excreted from the body. B vitamins and vitamin C can be easily supplemented in your diet to make up for loss from stress, but it is best to control stress. Although it is upsetting to have a sore—with the possibility of having to limit yourself for weeks or more—giving in to fears hinders the process of healing. Do what you can to avoid falling into the trap of constant emotional—and therefore physical—stress, which only interferes with your recovery. Don’t expect yourself to be upbeat all the time—it’s natural to be upset about a sore. But it need not be a continual state that will only interfere with healing.