Fragile Skin and cuts, increased CRP and Chest Infection and reducing pred.

[Buchanan16]

Hi you lovely people it doesnt seem that long since my last post asking for your advice regarding my 86 year old mums struggles with achilles tendonitis before my nieces wedding. As usual your advice was invaluable then and my mum managed to have a lovely day at the wedding and she looked beautiful.However the 2 day wedding took its toll on her and she was exhausted in the days afterwards so with our gps approval we have stayed at 15mg instead of reducing to 14mg as planned.

Anyway apologies as i digress from reason for my post.

My mums foot/ankle with achilles issue was extremely puffy and it was worrying my mum so we went to gp and they suggested various things to try which seem to have helped but they did a general check over and they also gave me results of her latest blood tests which showed her CRP had increased from 3 two weeks previously to 13 and ESR from 5 to 10. The CRP especially was a red flag to me that something was going on as its not been above 3 since her diagnosis in March. i did wonder if it was still leftover of stress and buildup of wedding but i wasnt surprised on examination that she had a creckle in her left lung although she didnt feel unwell i was so glad they have hopefully caught it early and she was given short course of antibiotics.

That was Friday and on Saturday she was drying herself after shower and managed to take a chunk out of her leg nearly giving my dad a heart attack in process as she came into kitchen with blood pouring down her leg. He cleaned it up and there is like a skin flap still attached so he covered it up with a dressing. It doesnt look great and im going to call doctors today as i would rather someone checked it over and advised if we are doing right thing with it. Her skin is so fragile and covered in bruises prob a combination of her age and her meds and now this.

Has anyone else had any issues with cuts ? How do they heal? Am i doing right thing in not reducing pred any further until after next blood test next week to make sure the chest infection and cut have healed?

She also has opthalmology appointment followup which i had chased up a scan for Urinary Tract which was requested by GP for recurrent urine infections she was having before GCA diagnosis and a chest xray on Thursday this week so a lot going on.

Its such a shame as she was feeling quite good this week and i actually thought we were maybe going to get a peaceful couple months or even weeks but its not to be.

Apologies again for such a long winded post and i thank you in advance if you have managed to read it all without giving up. As always your thoughts and any advice are greatly appreciated.

[SnazzyD]

Oh no, that all she needs! That wound does need looking at by someone who deals with wounds routinely ie a trained nurse rather then the GP. Even a picture is better than nothing. Flap injuries are a classic thin skin injury and can be as simple as putting the flap back and applying a dry dressing and waiting to requiring a full tissue viability assessment and more targeted dressings. Sometimes the flap takes and sometimes it doesn’t.

[Buchanan16 in reply to SnazzyD]

Thanks SnazzyD thats kind of what i thought. i called our doctors this morning who have been great with both my parents( my dad just told us last week he has been having trouble with his waterworks for few weeks so he has bloods getting done for that on Thursday As the saying goes it never rains but it pours )

The doctor on triage will call me back this morning and i will be requesting a nurse looks at wound asap. Ive just came away to our caravan for couple days with my husband daughter and grandaughter for a little break so my dad will need to take her this time which will be first time since GCA diagnosis ive not been at the doctors with my mum which does kind of stress me out a bit but im sure he will be fine.

Im assuming im right in not tapering any further while all this going on x

[SnazzyD in reply to Buchanan16]

I’d say don’t add a reduction into the mix.

[PMRpro Ambassador]

When I had a cut like that, it happened while I was in the rheumy clinic so I was sent along to the ED when I was finished with strict orders NOT to wriggle out. It was ajudged that it needed stitches to keep the flap in place because the skin was so thin - which was duly done by the surgeon on duty! It didn't quite heal in the alloted time so the GP left the stitches for another week. That was nearly a couple of years ago and the scar is finally fading but it healed very well in the end. But I am rather younger than your mum!

However - she needs the input of a nurse experienced in wound care, They should be able to assess if it needs stitches.

[Buchanan16 in reply to PMRpro]

Thank you we have myrse appointment this afternoon for her leg and drs app for tom morning to check her chest to see if she needs additional course antibiotics and to redo her bloods. We certainly cant complain about our doctors they have been fab.x

[RT18]

hope all goes well with nurse. Mum here is starting to get small cuts with her fragile skin. She scratches 🙈🙈 but hates having nails done 🙈🙈 so far nothing big and I am cleaning and dressing. So far they seem to heal pretty quickly. She doesn’t like me removing the dressing so I use ones with tape that I can cut and check all well underneath.

Bruising is another issue….they last for ages and she constantly looks battered but it doesn’t seem to bother her thankfully.

Keep going and enjoy ur little break 😀😀

[PMRpro Ambassador in reply to RT18]

Do you know about the bandage stuff that sticks to itself and not to skin? Most of the companies that make dressings do one.

elastoplast.com.au/products...

[RT18 in reply to PMRpro]

No, I’ve not seen this, thanks. Do you apply it directly to the wound or does it hold on the non adhesive dressing? I’ll have to try something else as she has bits of tape on her she won’t let me touch 🙈🙈

[PMRpro Ambassador in reply to RT18]

You use it to keep the nonadhesive dressing in place.

[Missus835]

Yes and recently. A plastic bottle fell off the seat of my walker and gashed my shin open. About the size of a coin. Skin flap still intact. My skin is also thin and tissue-ish. Washed it with saline solution. Put a little Polysporin and a large plaster. It is ok according to VON nurse. Leave skin flap on. No more Polysporin. Keep dry and covered. Keeping an eye on it. This happened 2 years ago almost in the same place. Problem this time, is it was 2 days before back surgery. Surgeon gave me the option of postponing due to this cut. I go back to VON today, so they can check my back and the cut. As of Monday last, needle holes in my back had healed over and cut no longer needed Polysporin. Eventually skin flap will dry up and fall off. If it does get wet, I am to wash with saline, dry well and cover. The last time I did this, it took about 2 months to heal.

[papadapadoo]

So far I have been able to mend skin flaps with a bandage that stays on for a week or so. Lately the bruising is a bit better, too, MAYBE because I have been taking hydrolyzed collagen supplements. Or maybe because I am down to 8Mg of prednisone daily. I do seem to heal in normal time. I'm 79.

[musicality]

Two of the intermittent ailments on meds have been UTI'S and also high calcium levels leading to heart valve problems. Damned if u do, and damned if you don't!

[PMRpro Ambassador in reply to musicality]

Were the UTIs really infections confirmed by culture - or were they the burning and urgency symptoms? Too much calcium can cause that too - I had to give up calcium supplements as did others.

[musicality in reply to PMRpro]

Confirmed by culture and given Nitrofurantoin anti-bees, but occasionally caught in time with just itching down below and strong pee before full blown cystitis set in. Told steroids can cause blood in urine too when no infection as happens periodically. Likewise blood glucose raised by steroids.

[PMRpro Ambassador in reply to musicality]

That's OK then.

[musicality in reply to PMRpro]

Thank you 🙂