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Our Wound Care Nurse Specialist is in to answer your health-related questions regarding wound and ostomy self-care management.
Unfortunately, due to the large number of questions we receive, we may not be able to respond to all questions. We will, however, try to answer those questions that we feel offer the broadest interest. Please check back periodically to see if your question - or a related question - has been answered. And remember, these responses are for educational purposes only - they should not be substituted for advice from your doctor. If you have an immediate medical concern, you should consult your doctor. If you have a wound/ostomy-related home health care need, please e-mail or call us at 1-888-VNS-1-CALL (1-888-867-1225).
Disclaimer: All information is for educational purposes only and should not be substituted for advice by your doctor.
Question:
Can you send me information on Una Boot dressings, the purpose of them, and how they work on wounds and any other purtnant information on Una boots.
Answer:
An unna's boot is a compression wrap, zinc-oxide based (like a cast). It is applied from the base of the toes to below the knee and is covered with a coban or sometimes an ace-wrap weekly. It is used to treat venous stasis ulcers or stasis dermatitis. It is not the best option for venous stasis ulcers as you do not get the sustained compression you would with more advanced multi-layer compression systems such as the proguide compression system. Before applying any compression, arterial disease needs to be ruled-out by a vascular work-up.
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Question:
Prior to vascular bypass surgery in his leg, my husband's doctor applied an una boot. This caused a wound in his leg at the back (by the ankle). (He is a diabetic.) What was the purpose of the una boot?
Answer:
An Unna's boot is one of several types of compression therapy used in the management of venous ulcers to improve venous return and reduce venous hypertension .In addition to providing compression; it also serves as a dressing.
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Question:
My dad is 93 and had emergency surgery for a perforated diverticulum in December of 2000. He has had to go to a nursing home due to his increasing medical needs and inability to deal with his colostomy. He has "accidents" at least 2 times daily where the wafer comes off his skin. The skin care specialist (nurse) who is employed by the nursing home says it is because the stoma is on a skin fold. This always seems to happen when we take him out and it is embarrassing and humiliating. I find it hard to believe that this problem cannot be solved with all of the products available. Can you help with this quality-of-life issue?
Answer:
The Wound, Ostomy and Continence Nursing Society certifies nurses in wound, ostomy and continence nursing (WOCN). Their Web site is WOCN.org and they have a listing of WOCNs that take referrals and list the Regional and Affiliate contact links as well. The Northeast Region of WOCN's web site is NERWOCN.org and does list WOCNs willing to accept referrals as well. If a stoma is in a skin fold, sometimes a special pouching system with/without additional products, or a custom-made appliance (where a mold is taken and a personalized appliance is made) can solve the problem of leakage. Sometimes, it's as simple as teaching the patient or caregiver to hold the patient's abdomen up so the skin fold is "open" and the abdomen is completely flat when the appliance is changed. There are times when leakage problems persist and the surgeon and patient consider the feasibility of a stoma revision of moving the stoma to another part of the abdomen. This requires surgical intervention and, given your father's age, may not be an optimal/viable solution.
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Question:
I am taking Neurontin for headache pain due to an auto accident. Will this medication cause weight gain or weight loss?
Answer:
Weight gain is listed as a common adverse reaction to Neurontin. You should ask your doctor or pharmacist to see what interactions might be possible with other medications you are taking.
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Question:
My mother has ulcers in her foot. I would like to know where I can buy Una boot medicated bandages. I live in Canada and my mother is in India.
Answer:
Una boots are used for lower extremity ulcers caused by venous stasis (poor blood flow out of the leg) which appear on the ankle area (not the foot). Appropriate vascular testing should confirm the ulcer is caused by venous stasis and that there is no compounding arterial insufficiency (poor blood flow into the leg) prior to the application of an Una boot type compression bandage system. The wound can be worsened and vascular (circulation) compromise can occur if there is arterial insufficiency or other etiology. The clinician applying the Una boot-type dressing needs to have skill in appropriate application as well. The www.WOCN.org Web site has more information. Go to Services and Resources and Related links. Scroll down to World Council of ET Services (WCET) and call them for a WOCN (ET) contact in India. Smith and Nephew makes a zinc oxide paste product (Una boot-type product) called Viscopaste. Www.Medicaledu.com is a Web site with the contact numbers for each of the manufacturers, including Smith and Nephew, for all wound care products. Smith and Nephew could tell you worldwide where their products are available. Any medical supplier should be able to obtain that product in Canada. The www.WOCN.org Web site has Clinical Fact Sheets listed under Publications on the menu bar. Click on Fact Sheets and scroll down to Clinical Fact Sheets. There is a Quick Reference Guide of multiple leg ulcers and an in-depth guide for venous stasis, arterial and diabetic neuropathic leg ulcers. The guide provides in-depth assessments confirming diagnosis and appropriate intervention or treatment options. These guides are for clinicians. WOCNs (ETs) are clinical specialists in the care of wounds, ostomies and continence.
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Question:
My 80-year-old mother needs to wear the Una boot on the advice of her doctor for a venous ulcer on the front of her leg. She wears only dress shoes and stockings as a habit that she will not break. How is the Una boot applied and does it cover the entire foot with a bulky bandage? How long do these ulcers last?
Answer:
The Wound, Ostomy and Continence Nursing society certified nurses in wound, ostomy and continence nursing (WOCN). Their Web site is www.WOCN.org and the site lists WOCNs that accept referrals and links to the Regional and Affiliate WOCN information as well in the United States. Additional information regarding evidence-based practice for venous ulcers is available on the site. Click on the Publications section of the banner, then on the Fact Sheets section of the side bar, and then scroll down to Clinical Fact Sheets until you reach the fact sheet for venous ulcers. Appropriate testing to confirm venous diagnosis, without complicating arterial and other co-morbidities, and clinical treatment options are listed in the fact sheet. A WOCN is familiar with different types of compression therapy and collaborates with the physician in facilitating physician orders for compression therapy that will be therapeutic and also congruent with the patient's preferences and lifestyle. This collaboration facilitates patient adherence to compression therapy, essential in the treatment treating venous stasis ulcers.
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Question:
Six years ago, my then 77-year-old father developed a chronic open would near his ankle (which I think is referred to as a venous leg ulcer). A wound specialist fitted him with compression hosiery, which he has worn every waking moment (not during sleep) for the past six years. The wound itself healed after the first several months. Consequently, his ability to walk briskly or even normally has deteriorated (he shuffles slowly), especially in the past year or so. Common sense suggests that this is due to calf-muscle atrophy from the constant state of compression on those muscles. I've researched this topic and found that he needs to wear these stockings for life, and that perhaps periodic Doppler ultrasound is advisable for measuring ankle brachial pressure to determine the extent of any arterial disease. My father also takes a daily dose of Coumadin and another pill for somewhat elevated blood pressure. He does not have a regular exercise regimen other than a little, non-aerobic daily walk. What kind of physical therapy, if any, is advisable to prevent further deterioration of his mobility? Are there new drugs and/or protocols in this type of therapy that would allow him to remove the hosiery for longer periods of time or use them intermittently, such as every other day?
Answer:
If vascular problems involving prior ulceration exist, a multidisciplinary approach is recommended: appropriate vascular testing by an vascular specialist, Wound, Ostomy and Continence Nurse evaluation (WOCN), rehabilitation specialist mobility assessment and complete geriatric assessment would be best. Maintaining quality of life and preventing risk of falls is important when mobility changes are noted. There could be changes in mobility related to other undiagnosed conditions as well. WOCN.org is the Web site of the WOCN advanced-practice nursing society. WOCNs are well informed regarding quality multidisciplinary wound centers and a holistic approach to care management. There are multiple forms of compression therapy to prevent recurrent venous ulceration that WOCNs are knowledgeable about and a medical doctor can order.
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Question:
I have a urostomy and my insurance does not pay for my supplies. Are there any programs that you know of that will help with the expenses of ostomy supplies?
Answer:
You can contact the manufacturer of professional services directly to see if they have a reduced-pricing policy, submitting your statement of financial need and income information. Each manufacturer handles that differently. Mail-order or larger national vendors tend to be less expensive than local supply dealers due to the sheer volume they order and tend to have reduced pricing. Check the United Ostomy Association Web site information regarding manufacturers and suppliers: www.uoa.org/chapc3.html. Consult with an advanced practice specialty nurse for ostomies, a Wound, Ostomy and Continence Nurse (WOCN), for longer-wear-time appliances (pouching systems) that are cost-effective (consulting WOCN information available at WOCN.org). A convex appliance and belt can extend wear time for urostomates. A WOCN can evaluate the best appliance.
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Question:
I am taking a drug called Norco (Hydrocodone APAP 10/325) twice daily for my headaches caused by a concussion. I have been taking this medication for a year already, and now it is starting not to work as well as it should. Do you think I’m building a resistance to the drug? Was it wise for the doctor to prescribe a narcotic for such a long period of time?
Answer:
A concussion is an acute event, and any related headaches should disappear. I suggest that you consult with a headache specialist and a pain specialist. At the very least, I recommend a consult with another primary care physician as soon as possible. A year is a very long time for symptoms to persist, and you need medical (doctor) assessment and intervention.
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Question:
Should any precautions be taken prior to flying for a person with a colostomy bag? We are planning on taking my mother on a three-hour flight and need to know if her bag will work differently due to the altitude.
Answer:
Ostomy patients can fly without any problems with their pouching systems. Since diet may vary with travel and there's decreased bathroom access, use a pouching system with a filter or an externally applied filter to your mother's existing colostomy pouch. This will prevent the pouch filling up with gas and there won't be an odor. WOCN.org is the Web site for National Wound, Ostomy and Continence nurses, WOCNs, who are available for consultation. The northeast regional Web site is www.NERWOCN.org and has similar information and other regional Web sites are listed on the WOCN.org site. The United Ostomy Association has patient educational materials on their Web site www.UOA.org, including local chapters.
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