Well, this wasn’t in my plan for Friday!

On the one hand its a complete pain in the leg whilst on the other its something different and possibly progress in the right direction.

This whole leg saga kicked off 30 years ago (see previous post) but this outbreak started in December and has been bloody agony throughout. All the nurses at our Doctors, (The Coven) have been brilliant but they’re not specialist wound nurses, some of them are just HCA’s so can only do the basics and then have to seek guidance for more difficult stuff.  

Once upon  a time it would have involved at referral to the lymphedema clinic at York District Hospital, as I was about 12 years ago in a previous outbreak. It was a “world leading” department and my referral resulted in probably the longest trouble free period. Someone decided they didn’t need it and closed it down.

N0w the process is that they refer the wound online to a tissue viability specialist who seems to pick things off a list with a pin to try, so far to no avail. Back in my late teens & early twenties meeting so many nurses was a dream night out but the problem now is one of consistency as you can see a different one each visit so they can’t tell if its changed since the last time the dressing was changed until one of the rising stars took a picture on her phone (well done Sarah, don’t ever loose your phone, your photo gallery must be pretty gruesome). That made me think that should be a pretty standard thing to do so I have been photographing my leg each time the dressings are changed.

Another problem is that they have their set ideas and each of them has a slightly different view and sometimes I can be telling them about the previous dressing/treatment/outbreak/cure and they’re clearly not listening. I’ve been telling them for weeks that its n0t the ulcer that hurts but all the breaks in the skin around it caused by the dressings and constant compression but they’re not listening and are just in ulcer car mode. There seems to be no recognition that the person with the most experience of my bad leg and the treatments is me!  I told one that this September is the 30th anniversary of wonky leg to the response, “I’m only 21”.

Progress in the right direction? Yesterday I saw a new member of the coven albeit only on alternate Fridays and it was a bit of a revelation. Rachel is a wound care specialist nurse who just deals with things like my wonky leg. I spent an hour with her discussing and creating a care plan and it was a revelation.

• Initial Care & dressing
• Next stage care
• Maintenance
• Prevention

The first thing is to get it healing and she has changed every aspect of the stuff in contact with my skin. The second is to really turn the screws on the compression. This has two functions, one is to squeeze the muck out of my compromised circulation and the second is to force blood to the surface to do the healing. In the past when I have had this (twice) its been done thigh to toe and is totally impractical and didn’t last very long. It depended on which of the three nurses who could apply it did it. With the worst it was round my ankles like Nora Batty’s stockings in less than a day. This lot is staying in place and despite it being uncomfortable and a bit painful its a lot better than the full leg version. I might not be able to get my shoes on or some narrower trousers but I can at least bend at the knee.

If this works it will be followed by something the maintain the improvement along with, hopefully, some preventative drug therapy and then a longer term regime to stop it happening again.

What I have on now is  supposedly two layer full strength compression. Actually works out at 7 layers. There’s dressings on the wounds, (silver bearing stuff – stings like fcuk), none stick mesh, absorbent pads, sort of cotton wool padding/bandage, layer one of tight compression bandage wound one direction, layer two compression (a sort of plaster on a roll & sticky) wound the other way and finally yellow line tubular bandage.

Each of the compression layers are calibrated to apply 20 somethings of force (can’t remember the units she used, not PSI).

It wasn’t uncomfortable at first but it’s designed to tighten and it’s starting to ache now.