A lot of napping

Its been a few months since my last post because I've been busy running around. This current pic shows that my ulcer has healed up quite a bit over the last few months. The yellowish rough parts are dried skin or scabbed skin. I was the area with a washcloth & Hibeclens to remove what I can but I don't want to pull anything off because sometimes this leads to bleeding. I'm currently on 12mg of Prednisone and another drug that seems to make me sleepy. It seems the more i sleep the better my leg heals up. maybe it has something to do with the edema.

Mid November

This pic shows the area outside the ring healing. If I pull this rough skin/ scab it will either bleed or will display new skin beneath. So, I'll just wait for it to go away or be washed away while I shower. Again, I simply use a washcloth with some Hibiclens antimicrobial soap.

Mid October

My leg looks kind of "chubby" from the edema but I thought it looked better while I was taking the pic. As one can notice the 'ring' has gotten smaller. Again, I generally wash the ulcer with a washcloth with a squirt of Hibiclens while showering. The ulcer produces no pain so washing isn't an issue. After showering I let it dry real well and then apply some Neosporin on the edges after which I cover with a piece of  soft paper towel. "Viva" brand paper towel is the best I've found so far, soft and absorbent.

Also a good tape is required. I've been forced to use all types of tape throughout the years. Its best to purchase online. The medical tape I see at my local drugstores is really expensive about $6 bucks a roll and its low quality clowntape. The 3M Micropore tape works great. I like the 2" or 3" widths. Even when I had my "leaky leg" problem the Micropore tape held up. The pic shows a 6 pack of Micropore I just got online for about $10 bucks delivered.

To save a few bucks I have no problem using Wal-Mart or Target house label versions of Neosporin. I'm not sure why its so expensive. I have a Target near me so i nave been using their 'up&up' triple antibiotic salve. Its at least 50% less costly than the Neosporin brand.

Early Fall

This pic looks alot like the one from August. The actual size of the ulcer has been reduced. I've gotten a little bit of edema around the ankle and I had a flareup which has since healed, located on the side of my ankle. Flareups generally come about once every few months and follow the same routine. The area hurts like a deep pimple and then a purplish node or bulb appears, about the size of a pea. It breaks and bleeds like crazy. An actual hole will appear. After a few days it will heal up.I'm not sure why I get flareups. They just happen without warning. Even with the increase in exercise which seems to help the ulcer, it has no effect on flareups.

After a walk

I'm convinced that as I increase my amount of exercise I see an advancement in my ulcer's level of healing. My doc says that swimming is good for me but I don't have access to a pool normally so I'm forced to walk generally for my exercise. The last few months I have been removing thick bands of dry skin that surround the ulcer. As this dry skin is removed new, albeit scared skin is hiding underneath. The small patch of "missing" skin I had a few weeks ago has healed up.

Post Nashville

After a few weeks of swimming my ulcer has improved alot. Before every shower I feel around,  feeling for a "scab" or a ring of dried skin on the outer area. Every once and a while I'll pull it off or at least a piece off, exposing fresh skin underneath. In this pic one can see a patch of skin that has been removed. While removing my bandage a week ago, after a swim, this patch of skin came off with the tape. It came right off, like nothing. It stung like a bitch! A few days of neosporin and it has begun to heal up.

Summer Swimming

While swimming I crafted this "leg sock". I still have the bandage on underneath. I simply took a dress sock and cut off the end so that it may slide up my foot and onto the calf. It worked great!  

Looks about the same..

After looking over some of my older posts it seems not much progress has been made over the last few months. I used to have to change my dressing a few times a day. Then I moved on to a "pad". It was necessary because my ulcer was producing fluid. Well, now the "fluid phase" is over and It isn't necessary that I continue to use a "pad". These days I simply use a few squares of paper towel (Viva brand is the best)taped to my leg. After I shower, I use a little Neosporin and tape my towel on. It will last for the whole day.

Moving On

I took an hour or so of washing my ulcer with hydrogen peroxide before taking this picture. I just took a small glass of water and made a 50/50 mixture with the peroxide. Its painless. The white "gunk" that covers the ulcer sticks on really tight. A little peroxide wash can loosen things up. Again everything I do is pointed towards keeping my ulcer clean and dry. It allows the healing process to "do its thing". I have also noticed that the more exercise I do, walking, the better condition my leg seems to be. My problems with edema in both my legs is gone. It was such a pain in the ass I'm glad its gone away. I'm sure the exercise helped this out a lot. As we get better weather in NYC I'm sure I'll spend more time walking around.

I've lost about 30 pounds over the last few months and it seems to have helped out alot. It has allowed me to get some exercise done, walking. It may not seem like much but when you aren't doing anything except walking to the store or the bathroom an afternoon walk is a giant leap. The speed of healing of the ulcer has increased and my right leg has almost totally healed. If I didn't scratch my right leg so much it probably would have healed by now.

Pressure Socks

The pressure socks are a much better thing to deal with than those Uni boot wraps. The problem with the pressure socks is that they can hurt. When I first got them it was not possible to put them on because they were too tight. I stretched them over a few days and they worked out. Any gaps or slack in the sock and the edema will take advantage of it, sometimes creating strange bulges or bumps. They also cause a good deal of ankle pain. I can only wear them for a few hrs before removing them. Perhaps things will get easier as the fabric loosens up. They all start to lose tension after a few months of wear. So, I read. My problem with my right leg has healed enough where I no longer wear any bandages or pads at all. The issue of the 'weeping edema" or the fluids continually draining from my legs has stopped. This is great because it allows me to leave the house for much longer periods of time. The ulcer has continued to heal as the picture illustrates. My prednisone is at 20mg a day. And I continue to gently wash the ulcer with a warm washcloth and Hibiclens.

The New Year

This might look a tad messy but things are moving in the right direction. Every other time I shower I spend a moment rubbing a wash cloth over my ulcer. There is no pain. I just want to make sure things are as clean as they can be, Hibiclens, hot water, my wash cloth and some elbow grease.

After a few weeks of wearing the leg rap things cleared up. I no longer am wearing the wraps and have moved on to "compression socks". They have been ordered but i haven't received them yet. As the pic shows most of the ulcer has healed up. It has dried up and is surrounded by dried skin. My prdnisone was reduced to 30mg a day which so far has worked out. I have had a few flare ups but they don't last. It seems the trick was getting the water or edema out of my legs so that they could heal. I hated wearing the wraps but they did work as promised.

Still moving forward

I know the pic makes things look like a mess but there has been some real progress on my ulcer healing up. It shows about 3/4"-1" inches of new skin. My daily dosage of Prednisone has been reduced to 40mg a day. I was taking about 160mg a day about two months ago. The side effects were ruining me. Since the dosage reduction I've lost about 25lbs of water weight. My hands and arms have lost the puffy appearance. It seems every week my doc says that its my last week wearing the "uniboot" but the following week he'll say the same thing. I figure I've got about 4-5 weeks more of wearing this thing and then I'm going to be wearing something called a "pressure sock". I'm not sure what they are but I looked a few up on Amazon, about $25 a pair. I would love to get those on and lose what I've got now. Of course I'm happy to see progress on my leg and will do whatever is necessary to get things healed up.

Progress

Uniboot removed

Things really look like a mess here but they aren't bad. This pic was taken right after I cut off the cast. I wear this thing for a whole week and cut it off with a box cutter and some scissors. The whole area is loaded with dry skin, looks like dandruff. The white square thingy is actually a small section of the antibacterial pad they cover the ulcer with prior to wrapping things up. This pad usually melts away from body heat. Wearing this thing is a BIG PAIN IN THE ASS! Its impossible to shower while wearing it. I'm a 1 or 2 shower a day guy, so after a few days without a shower, I start losing my fukin' mind. The upside to all this is that this uniboot thing works. I've seen a 1/2" to 3/4" inch ribbon of new skin surrounding my shrinking ulcer, progress I haven't seen in years. I'm not sure how long I'll have to wear this thing but I sure hope it ain't much longer.

Bulb

The reduction of my Prednisone allowed this thing to pop up. It looks bad but doesn't hurt much. It grew fast, from red area to red ball in about two days. The slightest use of a washcloth pulled it apart as usual. Its just a mater of keeping the wound clean with a little dab of neosporin.

Uniboot II

The second week of wearing the boot didn't go so well because it started to slip off. It should be removed Friday morning before showering and the new one put on a few hours later. I cut it off my leg Wednesday afternoon because the slippage was exposing my ulcer and it wasn't possible to "fix". I took a box cutter and worked the fabric. It took about 5 min. The nurse told me to keep the boot dry. How am i supposed to bathe? A simple shower would too much water so I tried a kitchen trash bag and some tape. It works! It takes a good amount of tape though. I'm not sure how many weeks they are going to want me to wear this thing. The doc is very happy with the results so far.

Uniboot

I was sent to a specialist and he applied the "uniboot". It looks just like an Ace wrap that is worn for a solid week. It seems that my edema was preventing the leg from healing. After just one week progress was seen. I'm going to be wearing this boot thing for a few weeks. I'm not sure why its called a boot when it is simply a wrap. with a zinc/medicine patch placed on the ulcer, keeping it moist and prevent infection. We'll see where this road leads but so far so good.

Edema

The right side of my body has never been effected by anything. Lately it has been developing an edema that just comes and goes. Its been a side effect of the prednisone which I've been hoping to reduce/eliminate but so far my docs are not simpatico on its replacement.

Fast and Furious

Even though I am taking a heavy dose of Prednisone these flareups still occur. They can show up and develop like this one in less than 72 hrs. The top pic shows clearly the edema that my leg is experiencing. I went out to run some errands this morning and when I changed my clothes I noticed that the 'thing' had broken open. I simply cleaned it up the the best that I could and applied some Neosporin. It doesn't hurt but I am amazed that it showed up at all considering the dosage I'm taking.

The well is dry.

My leg stopped "dripping". Without warning or any changes it just stopped. I am so happy about this development I'm afraid of doing anything that might start the waterworks up again, like drinking a beer. When I change my dressing, about every 12 hrs or so, they are dry, a bit sticky. Great care is taken when removing my bandages because I don't want to pull off any tissue or "scabs". Doing so may produce a lot of bleeding. If the sight of blood makes you queasy then Pyoderma isn't for you. The pic is of a small patch of skin by my knee that refuses to heal up. I am still on the Prednisone but this little SOB popped up and doesn't want to go away. It doesn't hurt at all but the other day it started bleeding like a stuck pig. I was laughing while I was trying to stop the bleeding because it was coming out so fast. I had just gotten out of the shower and was sitting down to put a pad on the ulcer. This was when I noticed a stream of blood running down my calf onto the floor, my beautifully clean freshly polished hardwood floor. About ten minutes and a handful of paper towel later It stopped. I guess I washed a scab off while in the shower. It hasn't happened before or since. This is just some additional bullshit I have to keep an eye on. If this thing started bleeding while I was at the office it would of course be an embarrassing disaster.

Cravat

Necessity is the mother of invention. As crazy and potentially embarrassing it may be I find it necessary to wear a shirt or a cravat on my lower leg, all in the quest to soak up all of this exudate. A fresh bandage will be leaking fluid in less than one hour. I can't change my leg every hour so I'm forced to make adjustments. If I sit for awhile without the wrap, I'll have a puddle formed under my leg, looks like a bit of spilled water. I guess its a good thing my apt is all wood flooring.

My right foot has never been involved with much except suffering the side effects from my meds. As can been seen my foot is suffering from edema. The edema gets so bad that my shoes don't fit. I'm forced to wear sandals or athletic shoes with loosened lases. It comes and goes without warning. I can feel it in the morning when i get up because my feet and ankles feel "tight". I am supposed to be taken off the Prednisone over the next few months because I'm being introduced to a new drug. By July or August I should be totally off the Prednisone. I sure hope so.

New to the scene.

Considering the large amount of steroids I'm taking every day its amazing I managed to have a new flare up just below my knee. This area started to flare up about six weeks ago but my dermatologist hit it with a needle before it could become anything serious. So, I thought. It's come back. And boy was it fast. It went from small purple bump to actual hole in about three days. This pic was taken prior to going back to the dermatologist for additional shots. I hate having to deal with this Pyoderma bullshit. One of the few things I'm content about is that everything is located in one area, my leg. This would suck if it was on my face or my privates. How would one live a normal life with no skin on their face?

Well huh..

The dermatologist was surprised by how much the ulcer has healed over the last month. It all looks the same to me but there seems to have been some real progress. The increase in the Prednisone might be the reason. Its slow going. The only thing I'm doing different lately is soaking my leg in the tub for about 30min a few times a week. I have spent so much time avoiding water and contact in general on the ulcer It's kinda' odd having it submerged in water. It feels good, no pain. I just drizzle on some Hibiclens and read while my leg soaks. The goal is to just help clean up the ulcer in general. I am always making the effort to keep things clean and dry.

My apt bathroom is too small for a Jacuzzi bath but it would be great in a situation like this.

Tendersorb

The leg pad that I'm using is made by Kendall, a 5"x9" variation of the Tendersorb. These things work really well. I call these my "leg diapers". A few pieces of tape and a fresh pad takes about two minutes to change up. If this is something you might need you should get them online. I pay about $8 for a box of 36. A heck of a deal. My local NYC store would probably want $25 for the same thing, so shop around.

Exudate

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Little change

Not much has changed over the last few weeks. I went to see a surgeon that specialized in ulcers. He took a few pics with his phone and said that it was "interesting" but he offered nothing new. I'm so fucking happy that my condition was "interesting". It was waste of my afternoon.

The edema leakage issue slowed down for a few days last week but has since started up again. I've tried to note some change in diet or meds but nothing different was done. Its a real problem because I have to change the bandages after a few hrs because they are soaked. This makes things tricky when going to the office.

Clean but still mean

Any stinging I may have felt over the last few weeks has pretty much gone away. As the pic illustrates, the ulcer hasn't healed much at all considering the increase of Prednisone. I'm getting some bad side effects, bloating, weight gain, moon face, all the good ones. It really sucks.

The pic also shows some dead tissue that seems to be hanging around waiting for debridement. The best way to gently clean the area is using a soaked paper towel and warm water with some hydrogen peroxide. This mixture is almost painless and gently eats away dead tissues or dried blood with ease. After a 20 minute soaking the ulcer is almost squeaky clean.

Stings

These pictures show were things are at with my pyoderma. My 'chubby leg' looks like a sausage because of the Edema, that comes and goes. The B&W picture is just to show the area where it really stung. It has since gone away. The extra dab of neosporin did the trick i guess.
My increased Prednisone dosage should be having a much better effect than what I'm seeing now. When i first used it over two years ago it was like a magic bullet. The results were immediate and dramatic. Its not the case anymore. I'm not sure what my options will be if this new 'Prednisone push' is a dud. This fuking thing on my leg is making my life difficult.

Vitamins and stuff

My regimen of supplements has grown a tad. The 'D' was suggested by my dermatologist. The 'B1' was suggested by my Oncologist. I am on a treatment for cancer and the B1 is supposed help avoid neuropathy. So far so good. The Iron I only take occasionally. The brands are of my own choosing. They may cost a bit more, especially the Carlson, but they are the best.

Carlson makes the best fish oil pills. They are clean, non-offensive tasting and offer a wide variety. I worked at a health food store for almost a year, twelve years ago. so It was like getting a free education on supplements. Some fish oil pills taste truly awful, sweaty dumpster oil tasting! A neutral tasting pill taken with a bite of food should do the trick for those easily offended by 'fish pills'.

Edema

My right leg/foot has always been free of any nonsense that I have experienced over the last few years. Without any warning my right foot and leg has exhibited edema, not a good thing. Everything has occurred on my LEFT foot/leg. The thought of "it" spreading to my other leg/foot makes me sick.

My Prednisone was increased last week(120mg/day) in an effort to 'heal up' my ulcer. My face is getting so chubby, a side effect, I joke that I'm turning Korean. Again, NOT a good thing.

Complications

Although I've been taking a higher dosage of Prednisone than usual, my ulcer has been getting bigger. The dark red edges sting. For an unknown reason my ulcer 'weeps', produces edema fluid in unmanageable amounts. It has happened in the past for a day or so and then stops, all for no reason.

Well, its been in 'weep' mode for about a week. When I sit at my computer at home, I do it with my foot on a towel. After a two hours its soaked! This prevents me from going to my office. I'm lucky that I'm able to work from home, but I don't like working from home. I have interns that I'm supposed to be helping out, not an easy thing to do from home. My dermatologist wants to raise my prednisone to a high level again, temporarily, just to heal things up.

Adjustments

I have been taking a higher amount of Pednisone the last few weeks. After a few days of 30mg/day its obvious that this dosage is insufficient. The front of my leg is unchanged. The back however has various developments, arrested only by a dose of prednisone.

In the shower I make an effort to keep my leg clean with hibiclens. Great stuff but it stains! Things look really bad after I shower which seems odd but, it is what it is.

Current suck-ness

For whatever reason my leg has begun to go the edema route again. I have raised my Prednisone dosage after last weeks flareup and have seen immediate results. The original ulcer in the front has simply stopped healing and is taking on a bizarre shape due to the edema in the surrounding area.

Flare ups

After being on a Prednisone regimen of 40/0/40 for about six months, I had a flare up. I must have forgotten to take my dosage because the day after my skipped day I could feel that my calf was getting 'thick' with edema. I didn't think much of it until I noticed the multiple hot spots on the back area of my calf. The back of my calf has been totally free of any pyoderma until just recently. All flare ups are preceded by 24+ hrs of edema. I'm currently taking 40mg of prednisone a day, perhaps more if needed, to stamp this nonsense down.

A new one.

After months of what could be best described as 'dormant', the front of my shin hasn't changed at all. No progress and no 'falling back'. That is until last week. My ankle was sore, it looked swollen. After a few days the false boil showed itself. As one can see, my anke is still showing signs of edema and the new ulcer or eruption is about the size of a dime.

I am taking a battery of meds so I'm surprised that this thing showed up. Surprised and worried, actually..

Slight progress

As the weeks wear on my ulcer shows the slightest of improvements. My ulcer doesn't even sting anymore. An odd thing going on is this little 'node' that has popped up. It doesn't hurt and it is easily pressed down. It isn't hard but in fact soft almost sponge like. In the past I have had these node type things before, they just disappeared after a few weeks. This one has decided to hang on.

Not much changed

After a little more than a month on my new meds I don't feel different but my leg seems to have cleared up a tad. I'm not sure why the pic has a bluish hue. Its some odd effect from my camera. The actual level of pain or discomfort has gone down by a modest amount. In months past if I got my ulcer wet in the shower it would hurt or sting. Now there is only a slight sting.

I usually bandage my ulcer about twice a day with fresh gauze and ointment. For some odd reason over the last few weeks my ulcer has been 'leaking' clear fluid, edema fluid. This was a real problem a year ago before I started taking the steroids and my leg and ankle were visibly enlarged. Currently my leg doesn't seem enlarged at all, so this edema fluid is odd. I could lay the blame on my new medication but this mysterious edema leakage has happened in the past as well. It begins and ends within a week or so for no rhyme or reason. Its obvious when this is occurring because when I change my dressing its usually bone dry. During an edema spell my Telfas are soaked and even the gauze is damp. I expect this to end within a week or so, again with no explanation.

Spring is almost here..

On my last visit, my dermatologist was pleased with how 'clean' my ulcer was and the lack of a 'ridge line', something very common with Pyoderma. Because of the nice weather i find myself walking around more just for the heck of it, exercise and such. I'm not sure this has any effect on my ulcer. I doubt it.

The nerve pain I have been experiencing the last few months has been reduced by a satisfactory amount. I'm not sure how or why but it just progressed that way. The sharp nerve pain i would feel every time I bathed seems to be a thing of the past. I would love to have this healed up by summer, so that i could wear shorts or swim without wearing an Ace bandage. I fear that may be wishful thinking or a delusion of grandeur.

Nerve

As can be seen, edema has returned by a small amount. The lower part of the ulcer a short 'french fry' line can be seen. I think it's a nerve because if it is touched or pressed a bolt of pain shoots down my ankle into my foot. This explosion of pain is so great I simply can't put it into words. If you can imagine lightning in a bottle but instead in your foot, you'll get the idea. Thankfully this doesn't happen often.