Diehl Martin cancerblog@diehlmartin.com

Bed Sores, Skin Infections, And Such This section is for patients, care-givers, and medical personnel only. The subject material is unpleasant at best. My personal experience with dealing with pancreatic adenocarcinoma and its treatment as a patient is that, assuming the patient lives long enough, there is a significant possibility of developing some perfectly miserable symptoms. In my case, those symptoms involved persistent skin infections. Some patients will not live long enough to face this problem, but I have now lived more than two years past the diagnosis, and skin infections have been and continue to be a real problem. In the literature that the doctors typically give out when they prescribe cancer treatment, there is usually a paragraph or two concerning how the patient will develop a weakened immune system, and that it is important to reduce the exposure to infections of any sort. When we think of such things, what usually comes to mind are the bacterial or viral infections which we associate with colds, flu, and other contagious diseases. It is indeed a very good thing to avoid these, and so cancer patients stay away from large crowds, and rooms full of pre-schoolers. This works, but it covers only part of the problem. From my experience, what has been the bane of radiation and chemotherapy is the increased susceptibility to skin infections, and especially those associated with fungus, as opposed to being caused by a bacteria or virus. No one warned me about this, but it has been a real and continuing problem. Skin Infections Skin infections can come in many types, but mine were primarily caused by tinea corporis. This is the fungus which is usually associated with some forms of athelete's foot, or what is called “ringworm.” I developed patches of skin which were discolored a bit, and which were itchy. Now since it started on my bottom, I did not see the development, but only noticed the itching. Since I had other symptoms at the same time due to the side effects of the chemotherapy drugs (Xeloda – note that 5-FU is very similar in its side effects) I did not think anything of it. I incorrectly assumed that it was due to the shedding of skin layers which sometimes occurs with Xeloda. But then after a month or so, a patch developed on my upper thigh, which I could see, and I reported it to the doctor. By the time I started treatment for the skin infection, I had an infection covering more than 25 square inches, and which was spreading rapidly. Because chemotherapy cripples the immune system, if this were not treated quicky, it could have become much worse quickly. One does not usually think of a ringworm infection as life-threatening but in a cancer patient taking chemotherapy, it can become just exactly that. The drug which was prescribed came in a little tiny tube, and was fairly expensive. A single treatment, smearing the ointment on the infected areas, would use nearly a quarter of a tube of the ointment, and that had to be done twice a day. After a week of treatment, it had not really stopped spreading, because it would seem that the areas adjacent to the infected patches needed to be treated as well. I called the doctor's office, and asked if I could use a slightly different drug, one which was available over the counter, and was sold in much larger containers. He agreed with it, and so I proceeded. What I bought was 1% clotrimazole cream, which is available from the pharmacy in huge tubes, for the treatment of athelete's foot. Twice a day I would wash the area carefully, and apply the clotrimazole cream all over the area, not just where the infected patches were. That worked, but there were still problems. One problem was hair. Large amounts of hair made it difficult to get the area clean, and when the cream was applied, it got all matted and messy. I also suspected the hair as a medium which was spreading the infection. So the hair from the area was removed, very carefully shaved off, and this seemed to help quite a bit. It took approximately twelve weeks to get the infection cleared up. It took more than a dozen large tubes of 1% clotrimazole cream, which was spread liberally all the way from my waist down to my thighs. It was necessary to shower twice a day to prepare the area for the fresh application of the clotrimazole, making sure each time to get all of the previous batch of cream off. A clean set of underwear was needed at each treatment. Cleanliness is critical to getting rid of tinea corporis. By the time the treatment ended, nearly the entire area had been shaved clean. However, the infection was gone. If you are faced with such an infection, please get your doctor involved in the treatment. What worked for me may not work for you. Please deal with it as soon as you recognize it, since runaway infections can have dreadful side effects. Depending on what the infection is, it could kill you all by itself. Bed Sores  For about nine months, the cancer invaded areas of my mid-section which prevented me from being able to lie down. The pain which resulted from stretching out flat was excruciating, and the normal doses of the pain medications I took would not touch the pain. They tried stout doses of morphine and fentanyl, and never reached a dose sufficient to allow me to lie down normally. As such, for nine month I slept in a large reclining chair, and spent much of my day in similar types of accommodations. This allowed me to live without the serious pain, but it caused long-term pressure on the area of my bottom which took most of the weight while sitting in this position. There was about a 20 square inch area which was compressed heavily more than 16 hours per day, and as a result had lower circulation. As a result, I had been dealing with what appeared to be bed sores in this area. In order to deal with the sores and allow them to heal, it was necessary to reduce the amount of time during which the area was under pressure, and to spread the pressure out so it was not all concentrated in one area. Monica helped by putting together a better set of padding on which for me to sit, which included a layer of squishy foam which eliminated any pressure points, a bath towel to absorb moisture, and a baby blanket to provide a non-abrasive surface. I developed a routine of, each time I woke up at night, changing my position to the right, left, or center, to change which area was being compressed. During the day, pressure was taken off the area by finding a proper office chair, and sitting well-forward in it, which put the primary pressure on the bottoms of the thighs, well forward of the affected zone. Proper posture is a real aid here. The above was not enough, however. There were additional issues of cleanliness which had to be addressed. The area had to be kept clean and dry, if the sores were to have a chance to heal. In order to deal with severe pain from the tumors, I was on a large daily dose of pain medication. The pain prescriptions included celebrex, oxycontin, and darvocet. The pain medications caused massive constipation which, untreated, would prevent me from eating. To treat the constipation, I took large amounts of glycolax (polyethylene glycol 3350) which increased the motility above zero, but which left the stool wet and sticky. This complicated the matter of maintaining cleanliness, which was absolutely required in order to make the sores go away. I dealt with this by buying large containers of pre-moistened baby wipes, and using them to thoroughly clean the area after each bowel movement. Furthermore, the entire area was shaved so that the hair would not provide the structure for the mess to stick to. It was very inconvenient, but I did what I had to do in order to survive. To be a cancer survivor, it is necessary to bend my life to maximize my chances of survival. Everything I have described has been necessary. The problem did not gone away entirely, but was diminished by about 90%. It required continued attention to detail to keep the problem at bay. As long as I could lie down, there was continued pressure in this area, which caused the occasional new sore to appear. With continued diligence, those could be minimized, and life could go on. Final Thoughts For anyone considering doing what I have done, I have a few words of advice. First of all, for this sort of a routine to work, you have to do it consistently. It must become a way of life, something you just do every time. Second, while your situation probably varies from mine, the general rule is that cleanliness will virtually always help. Third, if you need help, get help. Do what you have to do to get the skin clean and dry. If you need help, get help. My cancer blog may be found here: http://diehlmartin.com/cancer.html Update Diehl Martin passed away in October 2007. If you need to contact someone, please contact Monica Martin. Last Change: 25 September 2006 diehlmartin.com is a trademark of Diehl Martin Contents, elements of style copyright 2006 by Diehl Martin