Pressure Sores

Please note that this was originally written on 11/14/08. As of right now–1/2/09–Grandpa does not currently have any pressure sores.

Last Saturday while I was drying Grandpa off from his shower I discovered two pressure sores on his bottom. They were in mirrored positions on the bottom of his buttocks–clearly the result from sitting in one place too long. It was a depressing discovery.

The sores themselves were not that bad. They were each maybe a quarter to a half inch in size, and in appearance like blisters. The skin was not broken. But what they were was another sign that things are becoming worse. It was the next milestone, the first foreshadowing of the things I will have to face.

They weren’t bad pressure sores. I put a band-aide over each, and they went down and went away over the next day. But I dread the pressure sores that won’t go away, and that will only get worse. The sores on found last Saturday were only the mildest of pressure sores, but it was a mark of how bad things are becoming, and how close we are getting to the end.

It would have been unremarkable if the pressure sores had been on his ankles, or his hips, where bones are near the surface. Already he has had very minor sores where his diaper chafed over his hips, and when that happened I would put padding between him and the diaper and they would go away. Those problems had a fairly easy solution. The big difference this time was that not only were these sores far larger than I had ever seen before, but they were on the bottom of his butt–that is the anatomical part on all of us which has the most padding. But Grandpa is eating so poorly, and shriveling up so much, that even his butt doesn’t have enough padding anymore. That was the really depressing part.

There are some easy alleviating measures that can be taken if a pressure sore appears on a hip or ankle (lay on the other side, apply more padding to the area) but if you get pressure sores on both (buttocks while sitting on a very comfortable couch), there isn’t much you can do the make the situation better. What are you going to do, sit on your head? Or perhaps suggest that he get up and walk around some more–oh, that’s right, he isn’t walking around because he can’t. The best possible solution would be to have Grandpa lay down some of the time instead of sitting up, but the very reason he spends so much time sitting up is because it is not comfortable for him to lay down (he is having issues with breathing problems). In facing the pressure sores on the bottom I had to face the question, “What do I do?” and I couldn’t come up with any answer. I couldn’t think of anything I could do.

The band-aides weren’t really a solution. They were more a “if this blister bursts I don’t want it to get infected so I’ll cover it” measure. But the sores got better simply because Grandpa was more active in the following days and so gave them a chance to heal. I didn’t really do anything. We were just lucky. But as Grandpa grows increasingly less mobile that path to easy healing will be increasingly less available.

Then what? Ah, that is when your mind starts playing with the “What ifs.” Do you know how nasty pressures sores can get? Check out the description of Stage IV. And here are some pictures. (Warning: the pictures are not pleasant, but I actually did not link to the really hideous pictures of pressure sores you can find. Those are enough to make a grown man scream.)

It was particularly frustrating when I went online to see what advice and help I could scrounge up for dealing with pressure sores. How to deal with pressure sores? Eat better. Drink better. Have better posture. It was very clearly confirmed to me (not that I didn’t already know it) that Grandpa has all of the problems that make him a perfect candidate for pressure sores. And the wonderful solution suggested by the health websites is to make all those problems go away. That way he won’t have pressure sores. Which means all of the wonderful advice was completely useless, because if Grandpa could eat better, drink better, and have better posture he wouldn’t have gotten pressure sores in the first place. It seemed nobody had any advice about what to do, if your patient isn’t eating well, isn’t drinking well, doesn’t have good posture, and is getting sores on the bottom of his behind. They say you should adjust the patient every two hours . . . but if the patient is not willing to lay down, and only sits on his butt, I guess that means I should just pick Grandpa up and shake him for a few minutes every two hours to get the blood flowing.

Enough of that. Sarcasm doesn’t help. Truly, physically making him adjust his weight occasionally is really all I can do. It feels like scant little help. But my sense is that nobody has any better ideas. And I don’t either.

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