‘Inside Out’ Approach To Treating Leg Ulcer

Oral anti-fungal sparks quick relief for stubborn case of lymphedema.

Mary has regained much of the mobility she lost while fighting lymphedema.

Of the hundreds, if not thousands of flowers that Mary Pinkney has planted, nourished and nurtured over the years, the one she found most beautiful was a purple rose that first bloomed several years ago.

Mary’s mother found that rose quite beautiful as well.

“My mother loved that purple rose so much that I eventually dug it out of my garden and replanted it in her yard,” Mary explains. “I grew pink and yellow roses, too, but that purple rose, that’s the one I’m most proud of.”

Growing roses requires a great deal of specialized care and patience, qualities that Mary provided an abundance of during her 25-year career as a teacher in elementary, middle and high schools.

“I probably liked teaching elementary school the most,” Mary offers. “The children at that age are a little more attentive and more eager to learn. But I loved all my students. I was more like a mother than a teacher to them.”

Not long ago, Mary found herself in need of some specialized care after she developed a bad case of lymphedema, a condition in which blockages in the lymphatic drainage system cause excessive swelling in the legs or arms.

In Mary’s case, the condition caused so much swelling and discomfort in her legs that she struggled to walk even short distances without assistance. Those struggles brought an abrupt end to her gardening and most of her other daily activities.

“The only time I didn’t have all that swelling in my legs was when I was lying down on the bed,” Mary laments. “I eventually got a recliner so that I could at least sit for a while with my feet up. But then I had a bad sore develop on my left shin.”

This ulcer soon became as problematic as the swelling. Despite medical treatment, it failed to heal and only grew larger over time. Mary’s doctor eventually referred her to the wound specialists at Advanced Wound, Ostomy and Continence Care.

50 Years of Experience

The four advanced practice nurses at Advanced Wound, Ostomy and Continence Care boast more than 50 combined years of experience in providing wound care, ostomy care, dermatological care, continence care and patient education.

“We are a patient-centered practice that uses evidence-based modalities in the treatment of our patients,” says team member Kristi Lord, DNP, MSN, APRN, FNP-C, CWS.

“We treat venous leg ulcers, diabetic foot ulcers, pressure ulcers and all other kinds of wounds. There is absolutely nothing on your body that we won’t try to fix if it has something to do with the skin or excretion.

“I say that because wounds and excretion are correlated. If you don’t properly rid your body of its waste, your wounds are not going to heal, or you’re going to get wounds you didn’t have before.

“Our goal is to help people live comfortably and, in terms of our continence care, we mainly instruct our patients how to improve that issue through pelvic floor exercises, therapy and education.”

When Kristi first visited Mary’s home, she was alarmed by what she found. Because the lymphedema had progressed to its fourth and most dangerous stage, the ulcer had grown as well to 9 centimeters long and 6 centimeters wide.

“If lymphedema is not treated, it goes through stages, and by the time it gets to stage 4, it becomes what’s referred to in slang terms as elephantiasis,” Kristi says, referring to an extreme enlargement and disfiguring of the limb.

“At this stage it can also result in the development of papilloma, which are wart-like lesions caused by an underlying fungus. At that stage, you can treat the lymphedema all you want, but you won’t get rid of the papilloma and ulcers unless you treat the fungus.”

Rapid Results

In treating Mary, Kristi first tried attacking the fungus with a topical ointment. She also applied compression wraps around Mary’s swollen legs in an effort to reduce the swelling. The compression wraps worked; the ointment did not.

“The problem was that the bacteria and fungus were all caught up in the little nooks and crannies around those lesions,” Kristi relates. “So, while the compression wraps were reducing the swelling a bit, the topical treatment wasn’t doing a thing.

“I knew then that all the medication in the world wasn’t going to get rid of those lesions or that sore, so I decided to treat the ulcer from the inside out. We did that by putting Mary on a course of itraconazole.”

Itraconazole is an anti-fungal designed to treat the specific fungus causing the papilloma on Mary’s leg. Mary received that medication in pill form, and it had the desired effect.

“I’m a very conservative practitioner, so placing someone on a course of oral medication is the last thing I want to do,” Kristi explains. “I had no choice with Mary, though, and the good news is, once she started that, she turned a corner and everything improved.”

The improvement was almost immediate. During the first week, the Itraconazole had already taken effect, and in combination with the topical medication, it sparked a rapid reduction in the size of the ulcer, papilloma and swelling.

“The results were great,” Kristi reports. “After being on the Itraconazole for one week, Mary’s ulcer was down to 8 by 5 centimeters in size, and it just kept getting smaller and smaller,” Kristi reports. “After five weeks, it was all gone.”

“I like to be up and moving around. I can do that now thanks to Kristi.” – Mary

While the ulcer disappeared, so too did the papilloma and the swelling, the latter of which soon diminished to a point where Mary could control it by wearing compression stockings instead of the larger compression wraps.

“Mary eventually lost 20 centimeters of swelling around her legs, which is huge,” Kristi notes. “That’s what allowed her to use the stockings. When I first met with her, her legs were too big for compression stockings, so we had to use the wraps.”

Mary has regained much of the mobility she lost while fighting the lymphedema. She hasn’t returned to gardening yet, but she’s walking without all the discomfort that limited her before.

“Oh, I feel much better,” Mary enthuses. “I like to be up and moving around and I can do that now thanks to Kristi and all she did for me. She’s really good, and did a great job of taking care of my legs and that nasty wound I had.

“One of the things I really like about her is that she is very patient. She takes her time and always makes sure to clean everything well and do things the right way. She spent a lot of time with me, and I really appreciate that. These days, you don’t find too many people as nice and caring as Kristi, and she does great work. I gladly recommend her to anyone.”

© FHCN article by Roy Cummings. Photo by Jordan Pysz.mkb
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