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.

Exudate

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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.

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.

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.

3mm deep

I had a conversation with the doc from Boston. It seems what I need to get done can be completed here in NYC. He has since spoken to my doctors (dermatologist and oncologist) and everybody seems to be on the same page.

Whenever I need to get a refill on a prescription from my dermatologist, I have to go and get my situation reviewed. This includes him saying 'its getting better' or 'its getting worse', a swab of the ulcer to check for infection(s), a measurement and my blood pressure checked. As the pic illustrates, my ulcer hasn't expanded much over the last few months but it has 'deepened'. The pic does a lousy job showing the ulcer's depth. The nurse said it was '3 millimeters deep'. I can't imagine it was too accurate because of the method employed but I can say that at 3mm or whatever, it fuggin hurts. I have some pain pills that i take from time to time just to deal with it. It feels like a super heated wire wrapped around my ankle or a chunk of glass under the skin. When it hurts really bad i can't get anything done. So, i just pop a pill and wait for it to 'go away'.

The new meds that I am supposed to take promise to heal up this leg and allow me to get off the prednisone. We shall see..

flare ups

As I continue to take a smaller dosage of Prednisone, my pyoderma is struggling to return. After a shower a few days ago i noticed that some of my skin 'came off'. this area has been healed up for almost a year. There isn't much I can do. I have put some Neosporin on it and am hoping for the best.

clearing up but a bit of a pain

After a few weeks of the Ultravate and Neosporin the majority of the 'yellow gunk' that was capping my ulcer has gone away. This is an advancement in the 'healing process' but is actually painful, a slight stinging pain.

My Prednisone has been reduced to a 40/0/30 regimen. So I am kinda happy about that. I spent a few days in the pool this week so I wrapped my leg with an Ace bandage, covering my dressing. I'm sure without the Ace, the dressing would have slipped off. Not a good thing.

Strange advance

After a few months of really no progress and for no reason, my ulcer has begun to shrink and 'dry out'. After changing my gauze, I could see some 'fluid loss' from the ulcer. It was slight but noticeable. Recently I have not seen any 'residue' on my gauze upon removal. Its stone dry. The only thing that I have done different recently is get some sun. I live a few blocks from Central Park (NYC) and I actually got a little 'sun burned', very rare for me. So, other than time under the sun and the drinking of Gatorade, my routine hasn't changed.

I am still taking 40mg of Prednisone every other day. And applying Neosporin and Ultravate to the ulcer.

Still hanging around..

Although I am happy about reducing my Prednisone intake, I have noticed some 'give back' in some of the gains I have experienced. I had hoped that my Prednisone regimen would be over by now but no such luck. Sometimes after a shower portions of the 'white cap' of this ulcer is washed away revealing ordinary sore tissue. I'm not sure why it is there but always comes back after its removal, so something is going on.

reduction

I am starting to eliminate taking any Prednisone every other day, 40mg on and 0mg off. As the pic(s) illustrate, some of the ulcer has returned, albeit in a much more mild form. When I shower, I apply Hibiclens (that strange expensive soap in the aqua blue bottle) to the area. It doesn't hurt at all and I know the area is as clean as can be expected. i don't rub or scrub the area because it would cause some bleeding. Its as if my skin is thin, easily damaged.

sleepy days

It may look painful but it doesn't hurt at all. The surrounding shiny skin is all scar tissue. The prednisone and/or the zoloft is making me really sleepy. Some days I feel as though i could sleep all day. Its difficult getting things done or staying on a schedule of any kind when its being interrupted by constant naps.

I do have a really comfy bed and I am a lazy ass but its much more than this. After a good sleep I'll be up for about an hour or so and then I need a nap, probably 2 or 3 hours.

edema is back, sort of

After a few months of being on Prednisone my leg is still effected by Pyoderma. My doc seems really pleased by the progress even though a plateau has been reached and even a little progress surrendered. My Prednisone has been lowered to 30mg a day which makes me happy but also a little nervous. The side effects of taking Prednisone really suck but the drug really works.

It seems I am supposed to go onto a new treatment in the following months. I'm not sure what it is or what its called but I'll find out soon enough.

This pic may seem a bit 'rough' but my leg is pretty healed up. I have been experiencing a lot of 'weeping' or fluid sheeting from a very localized spot. It looked like i was springing a leak! My doc said it was 'edema fluid'. I had to change my dressing about every three hours as opposed to about every 12+ hrs. Using absorbent dressings as opposed to the Telfas removed some of the tissue on my pyoderma ulcer, hence the reason it looks so red and banged up. It doesn't hurt except for a small stinging once in a while. Not a big deal..

Addl pics..

As the weeks roll on and I am taking this lower dose of Prednisone my ulcer seems to be slowly creeping back. I have been using a topical ointment, Ultravate (0.05%). It looks and feels like ordinary Neosporin but it actually does a good job of taming 'hot spots' that erupt on my skin. I just apply a small amount to the affected area twice a day and after a day or two any redness or soreness is gone.

As the pic illustrates, my leg is mostly covered by a scar. The damage to my skin was enough to ruin the hairs on my leg. My legs were generally hairy, nothing crazy, but still 'hairy'. It seems the follicles were removed when my skin was covered by this scar.

Progress as it is..

Here are two different pics of my leg from the other day. The photo effects were added to show what is still an 'ulcer' and what is actually a scar. I have some serious scaring on my leg. Other than ruining my possible career as a runway model for Vilebrequin, it doesn't bother me at all.

My Prednisone has been reduced to 40mg/day and I should be totally off it in the week(s) ahead. It seems my body has been generating the basic side effects of using Prednisone; acne, bulkiness in arms, neck and back, and 'moon face'. My face has gotten chubby. Its as if I am turning Korean!

As I have stated in the past, i have been diagnosed with Multiple Myeloma, cancer of the white blood cells, not a good thing. I'm at a very early 'stage 1', so early that no treatment will be begun until some point in the future, probably a year or so. My 'numbers' are confirmed but very very low. The new drug that i am supposed to take next week is supposed to help treat my Pyoderma but not interfere with any future cancer treatment options.

High Blood Pressure

My pressure is usually about 125/75. Since i've been taking the prednisone it has made my blood pressure really rise. because of this situation I have also been taking Lisinopril, 20mg/day. Even taking the blood pressure pill, I seem to still suffer from high pressure. i will prob increase the dosage or move on to another medication.

If you need to watch your blood pressure, this Omron machine is great. One button operation and easy to fit into luggage. I got it on Amazon.com for about $50 bucks. Heck of a deal..

Hair regrowth?

It seems that one of the side effects of Prednisone is hair growth. I noticed about a month ago while shaving that I had hair or stubble on the side of my head, the temple area. I never had hair there before.

Also, as the picture illustrates, I have had some hair loss as I've aged but some of it has grown back. After every shower I comb my hair back so I really am familiar with my hairline. The hairs on my temple are small white hairs, tiny. They have grown much larger and turned black. I'm sure when I stop taking the prednisone all of these hairs will fall out...