Prevention and care of bed sores
DEAR DR. DONOHUE: My mother had a stroke about a year ago. She’s confined mostly to bed, but she’s alert and wants to do as much as she can for herself. She lives with my husband, me and our children. Fortunately, I have a large family of brothers and sisters, and they all take their turn in helping out. My mother developed a bedsore that required her to go to the hospital and have some surgery done. I don’t want this to happen again. How can we prevent it? — S.S.
ANSWER: Bedsores have a more instructive name — pressure ulcers. Pressure is their cause. When skin and muscle are squeezed between two unyielding objects, a pressure ulcer is bound to occur. The unyielding objects are bone and mattress. Pressure stops blood flow to the compressed tissues. Deprived of blood with its oxygen and nutrients, skin and muscle break down.
Bedridden patients’ most vulnerable spots are their heels, buttocks and lower back. Essential for prevention of pressure ulcers is position change. At least every two hours, caregivers have to move patients from their back to their side, and then to the opposite side.
The mattress is another item that you have to address. More than a hundred different mattresses have been devised to prevent pressure ulcers, and they vary in their effectiveness and their cost. Gel, foam and air-and-water mattresses are the least expensive, yet fairly reliable. More expensive but even more effective is a mattress that alternates air flow into the mattress to constantly redistribute pressure on the patient. These mattresses are electrically powered.
Patients have to be kept dry, and they should not be put on an angle where they slide down toward the foot of the bed.
Wheelchair-bound patients require the same kind of repositioning if they are unable to make adjustments on their own. Special cushions can redistribute their body weight. Doughnut cushions are not the best products. A visiting nurse can give you instructions and direct you to products you might not be aware of.
DEAR DR. DONOHUE: I take propranolol for essential tremor. It has really helped me. I am only 44, and I wonder if I will have to take this for the rest of my life. Is it safe to take it for such a long time? — J.K.
ANSWER: For readers unfamiliar with essential tremor, it a very common kind of hand and sometimes head tremor that shows itself when purposeful movements are done — bringing a cup to the lips or handwriting. Observers think the person has a nervous tremor. It’s not nervous as in nerves. It’s an inherited condition that leads to faulty control of muscle action. Essential tremor is also mistaken for Parkinson’s disease.
Propranolol (Inderal) is taken for a number of other illnesses that are chronic illnesses for which medicine is lifelong. You don’t have to be concerned about having to take it for the rest of your life.
Primidone is another medicine that is effective for essential tremor — if you ever need to make a change.
DEAR DR. DONOHUE: Are avocados filled with cholesterol? Many people have told me they are. How much cholesterol is in one? I am careful about not eating high-cholesterol foods, but I do love avocados. — L.P.
ANSWER: You’ll be happy to learn that no member of the plant kingdom has any cholesterol in it.
Avocados do have fat, which makes them calorie-dense foods. One avocado has a little more than 300 calories. The fat is not the bad kind of fat; it is mostly unsaturated fat, the kind that doesn’t raise blood cholesterol. Unless an avocado messes up your daily calorie limit, you can keep eating them.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.