Pressure Sores: When Traditional Treatment Doesn’t Work

Everything within me groaned. Oh Lord, not again. Not another pressure sore. Not now. I’m starting a new job. I’m already behind from being sidetracked with a broken leg. I have family to take care of. I don’t have time for this. Enough’s enough!

Illustration by Michelle Scruggs

But there it was–a definite, bloody, inflamed wound on the back of my left heel. How did it start? I wish I knew. But then, if I could have felt the cause of the pressure, it wouldn’t have deteriorated into a sore.

Reluctantly I made an appointment with my primary care physician. He groaned, too. He’d observed my continuous health challenges for years now and marveled that I’ve maintained such a busy productive life since my T9 spinal cord injury 45 years ago. Due to a secondary progressive condition, syringomyelia, I am now a triplegic, making my wound care all the more difficult.

The doctor started me on oral antibiotics and referred me to Georgetown Hospital outpatient therapy in Austin, Texas, that same day, June 23, 2004. I met my capable therapist Kimi and her team members, Betsy and Pania, and started wound care.

No, I don’t wear regular shoes, only open heeled slides. No, I don’t let my heels press against the bed at night; I always sleep with a large pillow under my calves. No, I’m not diabetic. Yes, I am otherwise healthy and have good nutrition. No, I don’t know what caused it. …

Perhaps I injured my heel during a transfer. Perhaps the foot orthotic that stabilizes my left ankle during the night slipped onto my heel while I was sleeping. Perhaps I’m just too many years post-injury and time has taken its toll. Whatever the cause, the damage was done.

With my left ankle resting on my right knee, I watched as Kimi debrided the wound, meticulously slicing and picking off all the dead flesh. I couldn’t feel it, but still it bothered me to watch. It was too strong a reminder of my own vulnerability.

The wound measured 1.1 by 1.7 centimeters. Kimi cleaned it with saline solution, dressed it with a Duoderm Signadress and scheduled me to come in three times a week for the next month. But the anticipated month of healing turned into four. The Signadress worked well the first week, then the wound deteriorated. Kimi switched to Aquacel to absorb the drainage. For a week it improved, then regressed. Betsy added Mesalt dressings, which helped for a while, but then the wound grew larger. We returned to Signadress. Again there was progress for only a few days.

Two physical therapists thought the problem could be fungal, so they washed it out with Dakins. Nothing changed. The next week we were back to a saline wash and applied Miconazole, an antifungal. The wound grew larger and the surrounding tissue wasn’t healthy. We switched to Hydrofera Blue, an antibacterial foamy dressing, which also worked briefly and produced some granulation. It was always two steps forward and three steps backwards.

I religiously did wound care at home, closely following all the directives. Other PTs and my plastic surgeon consulted and suggested new dressings. Each new dressing worked for a while. Then always a few appointments later, my heel looked worse than when we first started.

The wound that had started at 1.1 by 1.7 centimeters diameter crept to a frightening 4 by 6 centimeters, drained continuously, tunneled, undermined and burrowed to the bone. After five weeks, it was so infected that red, fevered puffiness soared up my calf. Betsy sent me straight to the emergency room, even hinting that if we couldn’t reverse the progression, it could result in amputation. I refused to accept that thought.

The ER doctor wanted to admit me for inpatient intravenous antibiotic therapy. My schedule for the next few days was carved in concrete, so I negotiated: I would come in every day for 10 days for intramuscular injections of Rocephin. The injections did halt the infection, but still the wound itself remained defiant. Now in the center there was a growing black necrotic area that was too tightly adhered to debride.

I wondered if after 45 years of doggedly conquering each hurdle, I was finally past the point of no return. Does there eventually come a time when medicine has nothing left to offer? Now what? My whole busy schedule had to revolve around a 30-mile round trip to therapy three times a week. The dressing changes at home were laborious and time-consuming, especially with only partial use of one hand. I had to quit taking showers because they always caused a setback in healing. Even though I sponge-bathed every day, I felt dirty all the time. I wanted my life back!

One Saturday morning in October my clock radio routed me out of a deep sleep. I sat up in bed and began groggily but dutifully changing my dressing. My mind snapped to attention as I heard the program hosts, herbalists Bill and Margie Harshaw, talking about a topical herbal combination that rapidly and painlessly heals burns, many skin conditions and pressure sores.

Was this just a too-good-to-be-true infomercial? The hosts sounded credible and balanced, and what they were saying seemed well-documented, so I kept listening, straining for any clue that might facilitate healing.

The Harshaws credited a Dr. John Young, currently an ER physician in Florida, with formulating the herbal spray. Young had spent several years as director of a pediatric burn unit and several more years as a medical missionary to Swaziland and South Africa. In that setting he needed an effective, low-cost compound to treat the many skin diseases, burns and injuries he encountered. Everything on the market was too expensive, limited in its effectiveness, or too complicated for nonprofessional, nonsterile self-care in the villages.

Young began experimenting with various compounds until he came up with what has since become known as Miracle Mist Plus. To his amazement he realized it not only cleansed the wound, but also killed staph, strep, E. coli and pseudomonas bacteria in the wound bed and surrounding skin, and it accelerated new cell growth and healing. It was painless and could be easily applied by nonprofessionals or patients themselves. And the cost was a tiny fraction of traditional therapies.

Monday morning I left PT, discouraged over the lack of progress, wondering if the hinted amputation might eventually become reality. I drove straight to THG Health store in nearby Round Rock. I quizzed Bill Harshaw about potential damage from this spray. He assured me there were no side effects. He said it was so gentle it could be sprayed directly in the eyes to treat eye infections. Then spontaneously he sprayed it in his own eye and never flinched.

But how does it work? I demanded. It has a pH balance of 8, which turns the skin alkaline. Disease can’t live in an alkaline environment. The magnesium in the compound drives the ingredients into the center of the cell and detoxes it. It also instantly eases pain–not that it mattered in my case. Bill told me of its efficacy on burns, diabetic wounds and pressure sores. I had nothing to lose but $29.95.

That night I sprayed Miracle Mist Plus on my wound. It looked like water. Was this a hoax? I let it air dry as directed, then applied clean gauze. I repeated it twice Tuesday and again on Wednesday morning before I went to PT. Betsy and Kimi were astounded at the improvement in just 48 hours. They called in several other therapists to see. They were so impressed that they called the Harshaws and scheduled them to do an in-service for the clinic. For the first time in four months of therapy, the tide was turning.

I continued spraying on the Miracle Mist Plus at home, but soon began to see a pattern. When I would present my foot at PT after two days of home care, there was always visible improvement. But the next morning after PT, there was little visible improvement. When the Harshaws came to the clinic for the in-service, they explained that the saline solution the PTs used to clean the wound compromised the effectiveness of the Miracle Mist. The compound itself was a potent cleanser as well as an antimicrobial, antibacterial and new cell stimulator. We were also not supposed to debride any tissue except pieces that were about to slough off. No debriding, no saline cleanse? That sounded completely heretical in the world of wound care.

Once we discontinued the saline solution and the debriding, healing speeded up again. But it had been a really deep, nasty sore by the time I found Miracle Mist Plus. We had a lot of catching up to do. Miracle Mist was working better than any previous treatments, and healing was finally happening. There were a few minor setbacks along the way, but never like the setbacks I’d experienced with the prescription applications.

Sometimes new flesh would grow around the edge of the wound but not adhere to the wound bed. I was concerned that bacteria would get in the crevice under the new flesh. At one point the wound became weepy again and macerated–as if it had soaked in dishwater too long. And there was still that black necrotic area in the center. I called Young on the phone and explained my dilemma. He suggested leaving off the bandage until the maceration totally cleared. The Miracle Mist Plus would prevent infection starting in the exposed wound. And he insisted the necrosis would reverse in time–just keep spraying.

I didn’t do without the gauze bandage in the daytime because I didn’t want the open wound to rub against anything whenever I transferred. But at night I left off the bandage, letting my heel rest on a soft, clean handkerchief. I also began spraying the wound at least three times a day instead of just two. I added cayenne pepper capsules to my usual vitamin regimen to speed circulation to my extremities. It worked, but I did learn the hard way that I must take cayenne pepper with food to avoid stomach pain.

Within one day of that phone call to Young, the healing process was obvious again and the maceration disappeared. Within a few more days the new flesh began adhering and there was no evidence of tunneling. A week later I realized the necrotic area was pink and soft. All traces of black were gone. I actually didn’t think that was possible.

On a whim I began using Miracle Mist Plus to clean my stoma. I sprayed and gently blotted. All redness disappeared within hours, and there was none of the bleeding that even the gentlest soap and washcloth had always caused.

I’d like to say that the wound healed almost overnight. It didn’t. But it did heal. After four months of progressive deterioration with standard therapies, the next four more months of steady healing with Miracle Mist Plus was a fabulous trade. I went through four bottles at $29.95 each. The first four months of standard treatment cost my insurance company nearly $10,000 for physical therapy, supplies, ER visit, 10 days of outpatient IV injections at the hospital, and consultations with my primary care physician and plastic surgeon. That doesn’t begin to cover my own personal losses of time, activities, mileage, lost income and home wound care supplies.

With cost containment so critical right now, perhaps insurance companies and our sophisticated American medical community need to take a serious look at alternative medicines like Miracle Mist Plus. More info: www.healthylifeandtimes.com or 800/217-6677.

Sharon Gardner is a freelancer writer in Leander, Texas.

 

Wound Care: Avoiding Maceration

By Tim Gilmer

A pressure sore on a heel or protruding ankle bone (lateral malleolus) tends to heal slowly due to poor circulation to extremities and swelling that interferes with cellular nutrition and oxygen supply. Because of more than 35 years of alternately breaking down and healing, five separate cellulitis infections and three hospitalizations, both my right and left malleolus areas now resist healing. After reading Sharon Gardner’s story of successfully treating a heel wound with an inexpensive spray, I was eager to try Miracle Mist Plus. I asked Betsy Stanford, one of Gardner’s wound care specialists, if she had had any doubts about using the product since it does not conform to the recognized standard of care.

“In Sharon’s case, no, because her wound wasn’t responding to conventional care,” she said. “We want to do what is best for each individual patient. This treatment was not a textbook approach. We’re taught black-and-white, but we live in a gray world.”

My right malleolus wound had been treated unsuccessfully for about three months with various moist dressings. I suspected scar tissue was slowing the healing process, but the immediate problem was too much moisture. Moist dressings can create a harmful condition, maceration–in which tissue becomes sodden and devitalized–depending on amount of drainage and frequency of dressing changes. When this happens, healing is compromised and sores can even grow in size.

Even though current accepted practice assumes that a moist wound heals three to five times faster than a dry one, conventional moist dressings were too moist for my skin. The immediate borders of the wound were continually macerated, and the wound bed tended to form a thin yellow slough that also inhibited the healing process.

On April 21, under the care of a new wound care specialist, Sue Wilson of Good Samaritan Hospital in Portland, Ore., I began treatment with Miracle Mist. The wound measured 2.2 by 2.7 centimeters. The skin surrounding the wound was red and irritated. The walls of the wound perimeter looked rough. Wound depth was about 3 millimeters.

For one week I sprayed the wound with Miracle Mist twice daily and covered it with a clean, sterile 2-by-2-inch gauze pad, but excessive drainage still favored maceration. I began spraying and changing dressings three times daily and air-drying the wound for 15 to 30 minutes each dressing change, which mitigated maceration.

On May 5, two weeks from beginning the treatment, wound size remained the same, but surrounding redness and irritation had improved. Most importantly, the wound depth had lessened slightly adjacent to the wound borders. Over the next five weeks, wound depth continued to improve in an area covering about 25 percent of the wound surface. On June 2, after six weeks’ treatment with Miracle Mist, the wound measured 1.5 by 1.9 centimeters. Infilling had begun. However, formation of new healthy tissue was slow, and there was some concern about the long term viability of the tissue due to previous scar tissue in the area.

After six weeks, both Sue Wilson and I felt that continuing treatment with Miracle Mist was justified, but that careful management was critical. Interestingly, we discovered that gauze pads made by Kendall Curity did a better job of debriding devitalized tissue and removing slough than other brands.

Wound healing is a complex process. There are no quick fixes or miracle treatments. Other factors that require close attention, besides avoiding maceration, are avoiding excessive dryness, limiting swelling, minimizing or eliminating pressure on the wound, maintaining proper nutrition, avoiding cold temperatures, and careful debriding of slough and necrotic tissue.

 

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