Caregiver Perspective: Struggles with Skin Care
I am obsessed with Lynn’s skin. Many years ago I worked as a home health nurse and I saw some terrible bed sores that started out small and then progressed to craters. Some of the patients had their entire backsides destroyed. Most of the breakdown, I expect, was due to inattention but some was also due to poor nutrition and just the disease process the person had.
With progressive MS, secondary or primary, the person often is in a wheelchair or in bed most of the time. In either situation, the person’s ability to shift their position is very limited or maybe non-existent. I am by no means an expert when it comes to wound care but I know the importance of keeping the skin healthy and intact. Lynn cannot adjust himself at all. He can move his upper body slightly (which only serves to put him in some very awkward leaning positions) and we keep his lower body moving somewhat with the use of an electric exercise peddler.
His peddler rotates on a 15-minute schedule and he has just enough hand strength to flip the switch to re-start it most of the time. This peddler has done an amazing job of keeping the circulation in his legs working well so most of the time his skin on his feet looks good. I particularly watch his heels though due to the pressure on them from where I have to wrap his foot with an ace bandage to keep it attached to the pedals. If I don’t do a figure-eight wrap around the foot and pedal, his foot slips out fairly quickly. Therefore, the pressure points of the wrap must be inspected regularly. I keep padded bandages on his heels, the sides of his feet where the pedal strap touches, and across the top of his foot where the strap also makes contact. We use house slippers for his shoes so I can afford to switch them out often keeping them from wearing in the same spot all the time. I also use cream on his feet nightly to keep the skin soft and pliable which helps prevent cracking and potential skin breakdown. So far only one of the heels has given me any concern. It occasionally looks black, like a bruise, which indicates sever lack of blood to the area. When that happens I pad that area more to help reduce the direct pressure and that has helped so far.
Though I have not had any issues yet, the same skin care principles hold true for elbows if a person stays in bed a lot or shifts his/her weight with the elbows. Using sheep skin elbow protectors or towels under the elbows seems to work for us in that area.
I’m not as fortunate with his buttocks. I have been battling skin breakdown there for several months now and just can’t get it to heal completely and stay healed. Because his muscles spasms in his legs are so intense, he stays in his wheelchair at least 20 hours a day so he can use the peddler which helps relax the spasms. Though his seat cushion is an air flow type so that as he shifts his weight, the air re-distributes, he rarely shifts his weight so he is usually putting more pressure on one side than the other.
His right upper thigh where the leg transitions to the buttock just over the hip now has a 1 cm x 1 cm ulcer that is approximately 1/16 of an inch deep. It’s not draining but the skin around it is also getting irritated and I can feel hard areas just under the skin that is either inflammation or the beginning of infection. I think it’s just inflammation for now because it’s not that red but it’s become very painful for him. Though this ulcer sounds very small, it has dominated our life lately. He constantly needs me to adjust his sitting or re-distribute the cushion’s air, or inflate then deflate the cushion slightly, then add some sheep skin underneath the area or just do SOMETHING to make it better. He’s hurting and he needs me to fix it but I can only do short fixes. He’s pretty miserable to say the least and if he’s miserable so am I because he needs more attention and that takes away my time from getting other things done.
Currently the way I am treating this skin breakdown is with a slivabsorb ointment to keep any drainage from getting infected. I then put skin barrier cream all around the area and two non-stick pads over it. Since other areas of his buttock are now also showing slight skin breakdown, I’m putting the skin barrier cream all over most of his buttock. Then, I’m covering the cream with non-stick pads and taping the edges with as small amount of tape as possible (using paper tape or skin sensitive tape only). Most of the bandage is held in place with biker shorts which are tight enough to fit snugly and not bunch up or create folds which cause more irritation. I change his bandages twice a day because whenever I take his pants off to use the bathroom or to shower, the bandages come off, too.
So far, I’ve managed to heal all ulcers he has ever gotten before they have become infected or too large for me to treat on my own but I’m finding it more and more difficult to keep ahead of skin problems. As his condition becomes more prolonged (in that more time has passed that he can only sit and not stand), it’s taking its toll on his skin. My memories haunt me of what could happen. So, I keep battling the war every day but my knowledge of healing is limited and he continues to abuse the sites by constantly sitting on them. All I can do is my best (which lately doesn’t seem to be enough) and continue to pray for healing (which will be what fixes it in the end, I expect).