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When you develop a pressure ulcer (which means the same thing as "pressure sore" or "bedsore"), whatever the cause, getting medical treatment is only half the story. As important as it is to get the right medications, or the right medical procedures (which can include debridement, skin grafts, or surgery), it's just as important to do your part when you get home to make sure your ulcer heals completely. Proper home care gives you the best possible chance for a speedy and full recovery.
Since every pressure ulcer is unique (due to the location, stage, and size of the ulcer, and how it fits into your general health condition), your doctor will be able to advise you about the best home care program for your needs. If you do not understand your physician's instructions, ask him or her to make the directions perfectly clear for you. Also ask for a written copy of the instructions (in the language that you speak at home, if possible). Once you know your doctor's directions, it's your job to follow them. Another good idea is to set a follow-up appointment with the doctor before you leave the office, so you'll be sure to go back and see how the ulcer is healing or be able to solve any problems that may arise.
Typically, home care practices include:
Bedrest. Keeping pressure off the wound while it heals is essential. There's no set length of time to stay out of your chair and in bed; the pressure ulcer will heal at its own rate, and you just have to let it take its course. Spending time in bed doesn't have to be "wasted time," however; for example, Helen, one of the participants in our study, uses days she stays in bed to direct her care attendants to clean and organize her home. If you'd like to see more details about the importance of pressure reliefs, turn to the "Pressure Reliefs" section of this publication.
Changing dressings. Again, the doctor will instruct you how to change the dressing on your ulcer; Zoe, the sister of our study participant Howard, asked the nurses at the hospital to show her how to change Howard's dressings so she could become her brother's care attendant. You might need to put a special ointment or cream on the wound, or use a saline solution on the bandage, but only use what the doctor prescribes for you. Over-the-counter wound treatments, like alcohol, hydrogen peroxide or Bactine®, are too strong for the wound and are likely damage to your sensitive, healing skin. Your physician will also tell you how often to change the dressing.
Medications. Antibiotics can be very important in stopping a pressure ulcer from getting any worse. The doctor might give you an injection of antibiotics in the office, or, if you enter the hospital, you might get some through an IV drip. Whatever medications you get to take at home, be sure you take the right dose at the right time. It doesn't help your health to forget one dose and "make up for it" by taking two later; in fact, that might cause a bad reaction. Be sure you know if there are any precautions, or special conditions, for taking your meds, such as taking them with or without a meal, or if there are any foods you have to avoid while taking them. It's also important to take all of the meds prescribed to you, even if you think the ulcer has gone away and you don't need them anymore.
Nutrition. You may not think that what you eat has anything to do with how a pressure ulcer heals, but, surprisingly, your diet makes a big difference. For your skin to recover from any wound, including pressure ulcers, your body needs the elements found in good food that are building blocks of new, healthy skin, including amino acids (found in protein), vitamins and minerals 1. Eating healthy foods, especially protein, and being sure that you drink enough water and other fluids can support healing 2; your doctor or a nutritionist can suggest a good diet for you if you don't have an eating plan now. To read more details about how nutrition affects pressure ulcers, check the "Nutrition and weight" section in this publication.
Positioning. The position you are in when you sit or sleep can make a big difference in helping to keep pressure evenly distributed in your body, or in keeping weight off an area where a pressure ulcer has already formed 2. Your physician or health care professional can show you the best positions for your needs and help you decide if you need pillows, cushions or other support devices for correct positioning. Your care attendant can help make sure you use these positions.
Another way that people with spinal cord injuries often keep healthy at home is by finding new ways to do the activities they want or need to do. Occupational therapists can often help people find ways to "adapt" activities, in order to get things done well despite any challenges that a person's physical condition might present. It's interesting to notice that more than one of our study participants was unwilling to learn how to adapt activities, because to them, that meant "accepting" that their impairments were real, and that they were not going to be the way they were before their injuries. Rachel, for example, refused to have the controls of her truck adapted so that she could drive it herself, because "I don't see myself like this for the rest of my life...I mean, personally, I look forward to walking." She also relied on her mother to feed her rather than learning to feed herself. Similarly, Billy chose not to get involved in wheelchair sports, even though athletics were a large part of his life prior to his injury, because he felt that "it wouldn't be the same."
Perhaps not "accepting" their impairments helped contribute to the problems Rachel and Billy developed: Rachel got Stage 4 pressure ulcers on her feet, and also needed to have a colostomy (that is, an operation to allow her to have bowel movements through a surgical opening in her abdomen instead of through her bowels) and, later, a reversal of the colostomy; unfortunately, there were medical complications following the colostomy reversal that led to her sudden death. Billy is relatively young and relatively healthy, but he still has feelings of depression even though he has said that it was "time to wake up" and get himself stronger, physically and emotionally.
For more information about pressure ulcer treatment practices you can do yourself or with your care attendants at home, we refer you to Pressure Ulcers: What You Should Know, created by the Consortium for Spinal Cord Medicine, which is supported financially by the Paralyzed Veterans of America (PVA). This 45-page guide is easy to read and to use. You can also download a free copy in PDF format. Úlceras por Decúbito: Lo Que Usted Debe Saber Una Guía para Personas con Lesiones Medulares ha sido producida en Español de parte del PVA por el Consorcio de Medicina de la Médula Espinal. Usted puede llamar a 1-888-860-7244.
If you like to get information on the Internet, you might want to try this excellent ad-free website maintained by the University Health Care System, in Augusta, Georgia. The site has illustrations of pressure ulcers and links to more Internet sites that may help you; the information there is provided by Healthwise, which supplies content to WebMD, a website, run by the publicly-traded company WebMD Corporation, that displays ads along with health information. The University of Washington makes available a number of pamphlets and information pages online, including topics like Taking Care of Pressure Sores, Skin inspection, and a description of skin and skin care in general, What is healthy skin?. Living With Spinal Cord Injury, on the website of the American Occupational Therapy Association, is an overview of what occupational therapists can do in helping to design home health programs, including adapted activities.