#ClinicSpeak: pressure ulcers in MS

If you have a pressure ulcer you need to do something about it. #ClinicSpeak #MSBlog 

Dogs are increasingly being used as diagnosticians in medicine to help sniff out cancers and other metabolic conditions by using their ultra-sensitive sense of smell and their ability to learn and be trained. One condition that doesn't require a dog's nose are pressure ulcers. Patients with pressure ulcers have a characteristic smell; the bacteria and organisms that live in the ulcer produce odorants that is hard for the trained clinician to miss. 

Two week's ago when I collected one of my patients from the waiting room her odour told me that she had developed a pressure sore. My heart sank; the time and effort that goes into treating a pressure ulcer is enormous. Not to mention preventing it from reoccurring in the future. 

When I was training to be a neurologist pressure ulcers were the norm in patients with more advanced MS. Over the last two decades it is now unusual to see pressure ulcers. I say that, but in the last two years they are beginning to be more common. Why? I suspect like any other healthcare problem they are an indicator of austerity Britain; cut health and social care spending and you will see pressure sores becoming a problem again. In MS pressure ulcers are at the vanguard of a failing healthcare system

The paper below finds that pressure ulcers have a major impact on QoL for pwMS and they are strongly linked to problems with mobility. 

We are in the process of developing a C-QUIT (continuous quality improvement tool) with the idea of it being the 'carrot' and 'stick' to help drive adoption of the policies in the 'Brain Health: Time Matters' document. One metric that may get into the final tool is the proportion of pwMS with advanced disease who develop pressure ulcers. Pressure ulcers, or the lack of pressure ulcers, are a very good index of the quality care of care someone who is immobile is receiving. Do you agree? Keeping someone who is wheelchair, or bed, bound healthy and free of pressure sores takes resources and effort, not to mention love and compassion.  

If you are a carer, or a family member, of someone with advanced MS and they have a pressure ulcer or early skin changes suggestive of an early pressure ulcer, don't ignore the problem. Early intervention, or prevention, of pressure ulcers is better than having to wait until they are a problem. 

Please note that pressure ulcers are typically confined to people with advanced MS; if we can prevent, or delay, people getting advanced MS we should reduce this problem substantially. This is another reminder for us to treat MS early and effectively.

PaperpileMcGinnis et al. What is different for people with MS who have pressure ulcers: A reflective study of the impact upon people's quality of life? J Tissue Viability. 2015 Aug;24(3):83-90.

BACKGROUND: Multiple Sclerosis (MS) is a progressive, degenerative disease of the central nervous system. People with advanced disease who have compromised mobility, activity, sensory and/or cognitive abilities are at risk of pressure ulcers. Having a pressure ulcer has a substantial impact on a person's quality of life; a generic pressure ulcer Health Related Quality of Life (HRQL) framework has been used in this study.

AIM: To explore the views and opinions of patients with MS who have a pressure ulcer using a thematic framework and compare these to the general pressure ulcer population.

METHODS: Data for six MS patients was obtained through secondary analysis of transcripts from semi-structured interviews conducted during two studies which were part of a programme of HRQL Research.

FINDINGS: Patients with MS reported that their pressure ulcer affected their lives physically, psychologically and socially. All were confined to bed (as part of their pressure ulcer treatment) and therefore unable to participate in activities. Difficulties with movement and activity were partially attributed to the MS. Patients with MS did not report feeling ill with their pressure ulcer and expressed positive emotions and optimism. Pain or discomfort was a feature of the pressure ulcer for most patients.

CONCLUSIONS: Pressure ulcers have a major impact on QOL for all patients. Problems with mobility and activity associated with the pressure ulcer were confounded by the MS.

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