The sacral ulcer that I have on my left buttocks, also known as chronic pressure injury, pressure ulcer or bed sore, has been around since at least early 2017 (see photo above of my ulcer taken on 10 Dec 2018). It causes no pain due to my spinal cord injury, but has been discharging small quantities of exudate consistently, such that over a night of sleep, my shorts will have a wet stain on it in the morning on the spot where it touches my ulcer. Sometimes, there is blood, especially when I have sat for a while. Pressure ulcers usually form due to pressure, friction and stress on the skin, and because of work and disability, I have to be in a sitting position most of the time when I'm out of the bed from 7am to 7pm on weekdays. Due to my spinal cord injury, a sitting position is also an uncomfortable position, because there is less flesh on my buttocks to cushion me. Hence, I prefer cushioned seats. I also tend to shift my weight constantly on the buttocks when I'm in an upright sitting position due to the discomfort, when the "cushion effect" wears off. I shift less when I'm in a "lean back" position in my chair (if my chair can be reclined), which places less stress on my Sitz bones, also known as the ischial tuberosities.
Hence, I pay much attention to my right buttocks too, because I can feel the pain in my gluteal muscles when I shift weight too frequently, and the skin surrounding the pressure area on the Sitz bones is also becoming somewhat rough. This is where my OCD (Obsessive Compulsive Disorder) mental disorder usually sets in and I have to constantly remind myself not to overindulge in skin picking, although it is difficult to say no when I just have to pick a small freckle off my right buttocks' skin to make it smooth. So far it has worked for my right buttocks.
The problem with my left buttocks began some time in 2016, when my freckles picking became large freckle picking, which then started bleeding. After it stopped bleeding, a scab forms and after some time, in my impatience, I started picking the scab/eschar to smooth my skin again. Unfortunately, it did not always work and I cannot pick away the whole scab, only parts of it. Trying to do more led to more bleeding. This happened several times, until a pressure ulcer formed, which heals very slowly. Now, thankfully, I have the wisdom to use a nail clipper to trim the edges of my ulcer when there is excessive scab formation or where there is slough. This is called debridement of wounds.
My problems with skin picking did not begin in 2016. It recurred many months after I started work in 12 October 2015 after a long lapse since my first relapse of schizophrenia, depression and attempted suicide in 2011, and 2nd relapse of schizophrenia in 2013. The first occurrence of the skin picking disorder that I can remember was during my teenage years, where due to the stresses and anxiety of constant tests during my secondary school 'O' level studies at Dunman High and computer games addiction, I started picking the skin of my fingers and toes. This condition was somewhat reduced or stopped during the days of my national service between 1995 and 1997, but returned with a vengeance during my days in NTU from 1997 to 2001. I still remember picking the skin of my toes until the floor of my hostel room was filled with skin scraps. This problem persisted until my onset of schizophrenia in 2006, after which my memory of it was hazy. Presently, I do not pick my toe skin, but occasionally, I subconsciously pick the skin of my thumbs. I have to place an awareness over my movements in order to stop the picking.
As for my sacral ulcer, it is not only healing very slowly, but may also be the cause of my hematological changes or anemia (as evidenced in Reference 6 below), which led to my weakness to microwaves, thereby leading to dizziness. My situation with dizziness is described in Health dangers from Wi-Fi (and 4G) Microwaves - My Exposures. My sacral ulcer can also become infected, as evidenced recently on 23 November 2018, when I had to visit a doctor at a polyclinic in Singapore for pain and swelling in my left groin lymph nodes. These lymph nodes are my body's guardians against infections at my sacral ulcer. I was prescribed Augmentin (amoxicillin trihydrate-potassium clavulanate) 1g tablets for one week and Biotine (tetracycline hydrochloride) ointment, which I apply only once daily before sleep when there is lymph node pain. Both medicines are antibiotics and have worked to remove the pain and swelling thus far. Augmentin, however, causes an overgrowth of slough, but this may be a sign of accelerated healing, so debridement is necessary.
01 June 2019 Update
I've changed the title of this post to "Skin Picking Disorder, Ischial Ulcer". I found out about the change in the name of my ulcer after seeing a specialist at SGH's Plastic, Reconstructive & Aesthetic Surgery or Clinic J on 15 May 2019, when I had to pay more than $200 for specialist consultation, nurses services, and dressing consumables - very expensive. I should have deduced that my ulcer should be ischial after reading the web article about Sitz bones and ischial tuberosities, but I had not made the connection. It is also difficult to say that my polyclinic doctor was wrong in assuming that it was a sacral ulcer when I do not have the medical expertise to contradict her. Fortunately for me, the consumables which were a major part of my expenses were to last a few weeks, and I need not use nurses' services because my mother grudgingly accepted the doctor's suggestion to clean and do my dressings for the ischial ulcer. I was very thankful for my mother's assistance. Of course, that meant spending more money to buy consumables for wound cleaning, but this was less than having to take no pay leave (when I run out of leave) to visit nurses and pay for their daily services (the dressings have to be changed daily because they usually come apart in less than a day). Hence, I was relieved when another doctor, during my second visit to SGH Clinic J on 29 May 2019, told me that she could stitch/suture the wound to close it immediately. I declined the offer because the dressing consumables I bought on 15 May were not fully used and it would be a waste of money if I do not finish them. The delay in suturing would also allow more skin to grow over the wound for an easier suturing on my next appointment at Clinic J on 13 June.
References:
- How to care for pressure sores, medlineplus.gov/ency/patientinstructions/000740.htm
- Sitz Bones & the Art of Sitting, virginiahillyoga.com/sitz-bones-the-art-of-sitting/
- Mary Ellen Dziedzic, Fast Facts About Pressure Ulcer Care for Nurses, 2014
- Excoriation Disorder (Skin Picking or Dermatillomania), www.mentalhealthamerica.net/conditions/excoriation-disorder-skin-picking-or-dermatillomania
- Skin Picking Disorder (Excoriation), www.webmd.com/mental-health/skin-picking-disorder#1
- GP Neiva et al, Hematological change parameters in patients with pressure ulcer at long-term care hospital, www.ncbi.nlm.nih.gov/pmc/articles/PMC4872940/, 2014 Jul-Sep
- www.google.com