DEAR DR. DONOHUE: My mother, 91, has an open ulcer on her ankle. She is in constant pain. How can she get this healed, since the current treatment is not working? What kind of specialist deals with this? – A.W.
ANSWER: Many ankle ulcers arise from vein problems. Varicose veins, an old vein clot that has disturbed blood flow or defective vein valves can cause blood to pool in the leg veins and leak fluid into the surrounding tissues. This happens most often in the ankle area. In the fluid is fibrin, a clotting protein that acts like glue and prevents the circulation of tissue fluid and the flow of blood to the skin of the ankle. The skin breaks down, and an ulcer forms.
The first step in healing is to prevent fluid leakage from the veins. Your mother must elevate the involved leg above heart level four times a day for 30 minutes, and she should keep it at a lesser elevation as often as she can the rest of the time. She can walk if it’s not painful. Put 6-inch blocks under the posts at the foot of her bed to maintain leg elevation during sleep.
For a day or so, apply compresses to the ulcer that have been soaked in sterile salt water. Before removing the compress, make sure it is saturated so it doesn’t pull tissue off when you change it.
From that point on, cover the wound with a dressing such as Nu-gel or DuoDerm. There are others, so don’t fret if you can’t find those two. Over the dressing, put a compression elastic wrap, like an ACE bandage. It should go from foot to thigh and be snug but not overly tight.
You might not be able to do all this without a doctor’s help. The doctor has to remove any dead tissue in the ulcer before it will heal. He or she might prescribe antibiotic ointments. A skin graft could be necessary. And the doctor can determine if the cause is an artery blockage, which requires different treatment.
The varicose vein booklet doesn’t deal with ulcers, but it does deal with one of their main causes. Readers can obtain a copy by writing: Dr. Donohue – No. 108, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: My husband had polio back in the ’30s and now has postpolio syndrome. Will you please address this? Is there a medicine for it? – P.S.
ANSWER: The polio virus attacks nerve cells in the spinal cord and brain that control muscles. Without input from those nerves, muscles weaken and often are paralyzed. Many patients make a partial recovery from the initial infection, with other nerve cells taking over the function of the dead ones.
Some 25 to 35 years or more after the initial infection, about 30 percent of polio patients notice an onset of new muscle weakness and sometimes pain. Many experience fatigue. Overworked, aging nerve cells that came to the rescue have become worn out, and that accounts for the new weakness. This is postpolio syndrome.
There is no medicine for it. People should pace their activities. They might need assistance devices like braces. Above all, they need the guidance of a doctor conversant with the syndrome. Neurologists and physiatrists – physical-medicine doctors – are such doctors.
DEAR DR. DONOHUE: My family recently had a severe case of stomach cramps, fever and diarrhea. The doctor did stool cultures and found a bacterium called campylobacter, and we took antibiotics. My 18-month-old also had it. How did the baby and we pick this up? – S.G.
ANSWER: Campylobacter (CAMP-uh-low-BACK-tur) causes many cases of diarrhea. The campylobacter germ lives in the digestive tracts of many animals, both domestic and wild. Meat can become contaminated with it, especially poultry. Within a household, it can be passed from one person to the next by fingers coated with the germ. Diarrhea – sometimes bloody – and stomach cramps are its salient features. Headache and sore muscles can also be symptoms. It usually lasts from a day or two to as long as a week. You were wise to call the doctor. Babies with severe diarrhea quickly dehydrate.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.
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