July 28 to December 11 covers five months. The battle is over (the burning, itching and scratching).
We started with leftover Nystatin cream that worked the past two summers. No response. Got a new prescription. No response.
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| Cleaned skin break bleeding at both ends when found under right breast |
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| That afternoon on a hot July day |
Next the powder formulation was used with some response and then with variable response. Nine caregivers were available each day, three per shift, to apply the Nystatin at bedtime and in the morning.
In hindsight we could see a failure of treatment related to each 13-day supply bottle. There was not enough powder to treat under two breasts and in the tummy fold. This allowed the tummy fold area to grow even larger to the far side of her body on both sides. An order for a 52-day powder supply ended the shortage. [11:22 today text. Yesterday’s new cream prescription by the dermatologist is ready at Schnucks Pharmacy.]
A caregiver came in one evening during the first weeks of treatment, took a look and announced: “This looks so good there is no need to make an application”, and left. She also deviated from the protocol all the other caregivers followed for the duration of the battle. We then knew of two ways the every 12-hour treatment was being broken. (A third one we found: the need to set a uniform time rather than flow with the workload.)
As the weeks passed, I looked for alternate treatments and what could be used to prevent a new infection. Success always seemed not too far away.
The application site must be dry. Wash, rinse off the soap, and dry with a third washcloth. Even using individual washclothes for each breast and the tummy fold made little progress.
I then found a very small electric fan. Mini Rechargeable Folded Fan
Dry is dry. But DRY is air dry. The medication does not cling or form little balls but remains a very fine powder during application. We could now see a proper application.
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| Mini Rechargeable Folded Fan |
Dry is dry. But DRY is air dry. The medication does not cling or form little balls but remains a very fine powder during application. We could now see a proper application.
We now had a winning set of rules: (How this all came about is a long story.)
1. Wash with a no-rinse self-sudsing disposable washcloth (no soap).
2. Dry with a washcloth.
3. Air dry with the fan.
4. Make application, with fully exposed skin with Margaret on her bed, to the effected area and some of the surrounding skin.
5. Have one person observe that the above was actually done across the three shifts (me).
6. Set a uniform time to apply at 8:00 am and 8:00 pm.
A meeting on the 15thof November approved these rules for the last try before we called in a dermatologist. Later, Monday 3rdof December was the decision date to call it over. Monday AM it looked great. Monday PM the left breast was about as bad as it had been! Tuesday AM it was all clear again.
We went ahead with new rules for an additional week:
1. Clean with rinse-free disposable washcloth.
2. Wipe with dry washcloth.
3. Liberally dust with Zeasorb.
We got an appointment with a dermatologist. She called our work done on the upper body, however, during the past few weeks the rash appeared in the groin area. “Continue your preventative measures on the upper body.”
She gave us new rules for the groin area: (Starting today 12 December.)
1. Clean with rinse-free disposable washcloth.
2. Wipe with dry washcloth.
3. Apply and rub in a THIN layer of Nystatin Cream.
4. Dry with fan.
5. Dust with Zeasorb.
A thick layer of Nystatin Cream in the spring resulted in a sweaty gooey mess and no results.
We also needed to learn how to liberally apply Zeasorb properly. Each caregiver had her own way of doing this that in general, was to invert the container and shake vertically. Erica held the container on its side and shook horizontally about six inches above the affected area.
The first method produces an uneven distribution with clumps. The second creates a small snow shower that evenly covers the affected area and around the area. For someone new, this takes a bit of practice.
Our prediction is to have the infection over by New Year; a lot shorter than five months. Winter weather reduces getting an infection but did not prevent it from spreading. A change in the management of incontinence ware the past few weeks seems important here.
A new toileting and changing schedule was in our clean laundry cart. Everything to optimize the effects of Nystatin are now in place.
One day later. We were all surprised to see Margaret’s skin looking normal in all areas. What now must be called false positive blushes of red, that appear one day and vanish the next, can be caused by her clothing when she sleeps in a chair, and by pull-ups that were not changed soon enough.
Nystatin works, but only if the stringent conditions are met for a person who easily sweats during a very hot season.
[Three days later. We are so close to the end that I do not plan to write a second post on this topic, however the recent bizarre developments will need to be added when they can be put in proper perspective. I also need to get the fan resized and running.]
[Three days later. We are so close to the end that I do not plan to write a second post on this topic, however the recent bizarre developments will need to be added when they can be put in proper perspective. I also need to get the fan resized and running.]
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