For me, walking was a deal breaker. I have always walked everywhere, everywhere I've ever lived or visited. Most of my adult life, I have not owned a car. The idea of not being able to walk anywhere I want, whenever I want, over any kind of terrain, in any kind of weather was horrifying enough to keep me from going through with a life-saving -- and life-restoring -- amputation. But my surgeon assured me that if I worked really hard, there was no reason I couldn't regain this part of my life within a year from my surgery. Every source I contacted -- prosthetists, therapists, doctors, nurses -- assured me this was true. So I went ahead with it, and I did the work, and now I do walk everywhere I want. Nobody warned me about the chafing and blisters I'd have to deal with along the way, though, and when I did encounter them, nobody had any good solutions for me, especially not with my shape and peculiarly sensitive skin. Fortunately, I've been able to work up some solutions of my own, such as the "winged" sweat-blocking one in the previous post. Here's another:
The first couple of days that I walked the 1.3 mi. to work in 70-80°F weather, I developed a tiny blister (from a new shoe) on the back of my organic left heel, and an area about 2" x 6" of chafed-to-the-point-of-bleeding skin following the curve at the bottom of my right buttock. I also got chafed on the inside of my left buttock, over an area about 1" x 1/2", where the lip of the socket I'd outshrunk scraped and poked every time I took a step or otherwise changed position. I now have a socket which fits okay (I think true perfection is out of reach), but I am a plump, curvaceous woman with lots of -ahem- upholstery on my thighs, which change shape not only every time I move a centimeter (and I move a lot, and a lot more than a centimeter at a time), but every day of the month as I gain and lose water. So I still have these problems, frequently.
Like you, probably, I am not at liberty to sit down and mollycoddle myself; I have stuff to do! And I do not have time to run to the doctor every time I get scraped up, and even if I did, I frankly haven't found their expertise at bandaging wounds to be all that superior to mine, at least not locally. Meanwhile, ordinary band-aids, even the 2" x 3" latex-free kind which I tried first, did not help and may even have made things worse. Plus, I'm allergic to the adhesive. So last spring, I went (limping and mincing) to the drugstore seeking alternatives.
I had a number of considerations. Perhaps you share some of these:
1. I do not have a latex allergy, but I do not want to develop one, as have friends and acquaintances in the medical profession, to their complete debilitation. It is apparently possible for just about anyone to develop a latex allergy through simple overexposure. So I don't take chances with latex. No latex is good latex, to my mind.
2. I still have metastatic malignant melanoma. One challenge of metastatic malignant melanoma is that patients really must avoid things like sustained irritation to skin, opportunities for scarring, etc. Scars can turn into lesions/tumors as they are being formed. Infections can sustain irritations long enough to inspire rogue cell development. Therefore, I needed something that was going to immediately block further irritation, prevent infection, and if possible soften scar development.
3. I'm allergic to the adhesives used on every kind of first aid tape I've ever tried, even cloth and paper. Also, my experience with occlusive dressings such as Telfa pads that supposedly don't stick has been unfortunate, infectious even. I really needed something that wouldn't stick to my wound, but also that I wouldn't have to tape. Since I have blistered at the touch even of adhesives used on Band-Aids, I didn't know what was going to work for me and had to cross my fingers and take a big risk.
After reading a lot of packages, I settled on two likely products for my two separate and distinct wound types, took them home, and field-tested them thoroughly over the course of two or three weeks. Here are the results.
For the small blister on my heel, I initially chose Band-Aid brand "Advanced Healing Blister" bandages. There was not a lot of information either on the box or anywhere on the website, as far as I could tell, about these bandages or how they work; I did not even know if they were latex-free. I chose them because they were a brand I recognized, and because they seemed, by the picture, to be designed for just the problem I needed to address -- at least, one of them.
NOTE: There was a warning on the product information included in the box which read, "Diabetics and those with poor circulation or fragile skin should not use this product." If you are diabetic or have poor circulation, however, please don't feel like you're missing out on anything. My skin is sensitive, but not fragile; I'm not diabetic; and I have reasonably good circulation. I also only had a teeny tiny little blister on my heel. Nevertheless, this product failed to impress me favorably.
I purchased the largest size available in the heel-appropriate shape (an oval 1.16" x 2.16"), because at my size and level of full-body mobility, I've found it important to have at least one half inch sticking area extending in each direction from the area of the wound. However, no matter how I oriented it, each bandage's sticking power proved less effective than my shoe's ripping and moving power, and seemed powerless, too, against even the stretch of my heel's skin as I walked. Just for the sake of science, I even tried one on the small chafed area on the inside of my left buttock, where the skin is less mobile but the type of friction from my socket lip somewhat emulated that delivered upon my heel by the back of my newish shoe. No dice. These puppies would not stick, even though they are supposed to stay on for several days, even through bathing and swimming. The one placed on my inner buttock didn't last two hours. My socket lip made short work of it. The one placed horizontally on my heel lasted three hours before my shoe took it off. The one placed vertically peeled downward halfway, allowing shower water underneath and into the wound. Infection, skin cracking, and bleeding ensued. Grrrrr.
The up side is that I never developed an allergic reaction to the adhesive, and that I was able to clean and rest the wound, and then try something else which seemed to work much better.
For the massive areas of chafing, I chose the Doctor's Choice brand "Advanced Wound Care" bandages designed for "Burns, Scalds, Abrasions." (Boy, did I have abrasions!) Unlike the lousy Band-Aids, these included a lot of information (which I will liberally quote for you here), yet absolutely no restrictions regarding diabetes, circulation, or fragile skin issues. (This particular type of bandage does say it should only be used in cases of 1st degree burns or abrasions; since they did eventually get bad enough to bleed, it's possible my abrasions were 2nd-degree, but I used these anyway.) They are latex-free and packaged in latex-free packaging, and it says so clearly on the package. Like the Band-Aids, the entire surface of each dressing is adhesive; there's no pad module glued to a separate element of adhesive plastic. However, the surface of each is also coated with something called a "hydrocolloid mass (blended with the adhesive) [which] liquifies and forms a humid contact gel, thus creating favorable conditions for the healing process."
The bandage is almost paper thin, only swelling where required once exposed to a wound. It detaches itself when it's used up, sometimes "very quickly if the burn, scald or abrasion is weeping (fluids) continuously. The bandage functions similar[ly] to a sponge, absorbing fluids while it retains your body's natural fluids to rebuild your epidermal (skin) layers and restore your skin's natural moisture level." Furthermore the hypoallergenic (!!!) adhesive "covers damaged nerve endings" allowing for "less pain throughout the healing process. No hard scab forms."
I assure you this is not just propaganda. This has been my experience with this product, all the way. (I used it all summer and have started up with them again this spring. I had to turn to another solution in winter, which I will explain and describe in another post.) It's like this bandage was tailor-made just for someone as fussy as I have to be! Using the largest size (3" x 3.25") everywhere except my heel, where I applied a 1.5" x 3" one vertically, I experienced elimination of pain, comfortable slow healing, protection from infection, and no scarring. I've had no allergic reaction. I'm able to go about my life without missing a beat, wearing my socket and walking wherever I wish, without pain or further injury. I wear them prophylactically on areas I know to be prone to trouble. When I do sustain another injury, due to changes in shape or fit of the socket or change in my own habits, I just slap one of these on it and keep going. I only have to reapply once every five days or so. Because it comes in sizes large enough to cover the wounds with plenty of extra area just for gripping, neither my socket nor my shoe has been able to take one off easily except in very hot weather when I sweat a lot. Even when edges peel, which they do a little bit, no bandage has yet allowed liquid into any wound.
The down side: Each package of five bandages, two 3" x 3.25" and three 1.5" x 3", costs about US$7, and there are no packages of five in just one size. I don't get a lot of heel blisters anymore, so a 5-pack includes two bandages in a size I can't use without overlapping (not big enough to stay put without peeling under intense moving pressure), and overlapping creates lumps. I earn less than $10 an hour at my retail job. During the hottest, sweatiest season of the year, I can go through three or more of these bandages (one package, minimum) a day. But dang! These things are awesome, worth every penny, especially since each one stays on so long.
I have written to the company which makes these, SciVolutions, Inc. Alan Nash, the president of the company, tells me that when they first introduced the product, they proposed packages of all one size, but the stores only wanted assortments. He has indicated that he would love to hear from any other amputees (or anyone else) finding these useful but having issues with the unit pricing. Meanwhile, I unreservedly recommend this product for amputees on the go who have been unable to find better solutions to the kind of problem I've described here.
UPDATE, 10/01/05: This just in (well, in 9/24/05; sorry, I'm running behind) from Bonnie of Amputeehee:
"[L]ast week I read the older post to your blog about the bandages...and I thought, hmm! That could really work for me! Your sores sounded a lot like the ones I got in June while was cruising Disneyland with my kid...and they kept me out of the leg for two weeks. I didn't think I'd be able to find the exact same bandages, but hoped for something close. And I figured even if it wasn't an exact match, I'd be fine with something similar as I don't have the same skin sensitivity issues (or so I thought!).
"So I was at a big chain supermarket Wednesday and I decided to peruse the first aid aisle...and lo and behold, there they were! The same exact bandages, and at only $4.99, I might add! So I bought a box and my plan was to keep them on hand for when I start walking with new socket in a few weeks....but then I had this great idea to use them another way.
"Every once in awhile, I get these huge chafe marks under my arms from my crutches, about four inches down from the pit on my ribcage...kinda rug burn-ish. And they suck. They hurt enough sometimes to force me into a wheelchair, which is not my favorite place to be (because I can go EVERYWHERE with my crutches, even hiking). I've never been able to figure out exactly what causes the chafing. I thought it might be my sweetie's laundry detergent (sometimes I'll borrow a t-shirt), or maybe the cut of different shirts (t-shirt vs. raglan, for example). Then again, it might just be sloppy crutching. But I can't find a consistent reason. I usually just use Band Aids when it happens, and they're okay, but they don't stay on well and they have no soothing/healing ingredient like yours do.
"Anywhoo. So I slapped on the bandages. They were a great relief initially, even though they came off pretty quickly. When I reapplied, I put them on vertically instead of horizontally, and they seemed to stay on real well. Like 'it hurts to take them off to change them' real well. And that was bad, because I needed to get them off. They actually softened up the chafe spot enough to make it start to weep ... AND now I have a red splotchy rash mirroring the exact shape of the friggin' bandages! LOLOL It's pretty funny looking.
"SO. Back to the drawing board for me LOL. I think I might try teflex stuff...you know, the thin dressing stuff they put on over stitches and such. It's real similar to the bandages you recommended, but it doesn't have the medicine in it. I might even try first aid tape. I haven't done that yet on the pits yet, but I've taped toes and I've also had lots of taped dressings for awhile with no allergic reaction...so we'll see!
"Do you have any other thoughts?"
I replied that I was naturally very surprised, and that her experience was so very different from mine that it didn't even sound like the same product. She replied:
"Same exact product.
"I clicked on the link in your blog to see the box and description before I went looking, and I just now clicked again to compare boxes/details to confirm. If I had a digital camera, I'd send you the pic, but I dont :-( Anyhow, it sucks they dont work for me...but maybe my leg will respond differently than my pits?? (Doubtful, but maybe I should stick one on now while I'm between legs and it doesn't matter so much, and see what happens.)"
So there you have it. There is no magic bullet which will solve everyone's chafing problems, everywhere, every time.
Meanwhile, besides BodyGlide (which I wrote about here), I have no suggestions on how Bonnie can relieve her crutch chafing. I did tell her that I had similar problems with crutches, but that they also crunched my wrists, which I need for my artwork, so I have ended up almost always using a wheelchair when I'm not in my leg. (As I told her, the only thing a wheelchair ever did to me was widen my ass.) I told her I would avoid Telfa (if that's what she means by "teflex"). The stinky, colorful, and incurable infection I got from one week of wearing the occlusive Telfa dressing applied to my bleeding tumor in a major teaching hospital by an ostensibly well-meaning Harvard God of Orthopaedic Oncological Surgery made the last two months I owned my original right leg smelly, itchy, oozy hell.
However, there's some other stuff my prosthetist recommended, but I can't remember the name and I couldn't find it around here. He said using it on boo-boos was like wrapping raw meat, and very effective as both protection and pain solution. It's an older product, probably full of latex and totally allergenic adhesive, but he liked it. If I remember the name, I'll share it here.
Meanwhile, I'm sure Bonnie and anyone else suffering with this issue would be grateful for other ideas. Please post 'em if you've got 'em!
(And thanks, Bonnie, for that useful feedback!)